LIBRARY OF CONGRESS. 



Shelf. JfetStf 



UNITED STATES OF AMERICA. 






APR 23 1885 



MODERN THERAPEUTICS 



OF THE 



DISEASES OF CHILDREN, 



WITH OBSERVATIONS ON THE HYGIENE 
OF INFANCY. 



/BY 



JOSEPH F. EDWARDS, M. D., 

EDITOR OF THE ANNALS OF HYGIENE, ASSOCIATE EDITOR OF THE MEDICAL 
AND SURGICAL REPORTER, AUTHOR OF "BRIGHT'S DISEASE AND 
ITS TREATMENT," FELLOW OF THE COLLEGE OF PHY- 
SICIANS OF PHILADELPHIA, ETC,, ETC. 




PHILADELPHIA : 

D. G. BRINTON, 115 SOUTH SEYENTH ST. 

1885. 






Entered according to Act of Congress in the Library of Congress, by 
D. G. BRINTON, 1885. 



PREFACE. 

It is the purpose of this work to present in a concise manner the 
results of the modern applications of therapeutics (in its wider sense) 
to the Diseases of Children. As in the other numbers of the series of 
which this volume is a part, the effort is made to give the details of the 
treatment of the most eminent specialists in this branch, both American 
and foreign. Journals, monographs, and treatises on the subject have 
been carefully scanned, so as to glean both that which long experience 
has proved to be advantageous, and that which recent discovery has in- 
troduced with a fair promise of value. 

No similar work of anything like this extent has ever been published 

devoted to this particular field, and it is hoped that the profession will 

find in these pages suggestions of practical utility, and a trustworthy 

adviser in combating disease. 

( iii ) 



TABLE OF CONTENTS. 



PAGE. 

Preface iii 

Table op Contents v-vii 

Therapeutics of Infancy and Childhood (General Remarks) „17 

Clinical Examination of Children .... 18 

Alimentation of Young Children 23 

Mental Disease in School Children 23 

Malingering in Children 24 

Cinchona in Childhood 25 

School Hygiene 26 

Natural Mineral Waters in Childhood 27 

Milk Diet in Childhood • • 32 

Anaesthetics in Children 33 

Valuable Aphorisms 35 

Combating Fever in Young Children 36 

Treatment of the Newly-born 37 

Artificial Feeding of Infants 37 

Special Therapeutical Methods 43 

Ap^emia 47 

Notes on Remedies 48 

Aphthje op the Palate 49 

Bronchitis (Acute) 50 

Bronchitis (Chronic). . 58 

Notes on Remedies 59 

Cephalhematoma 60 

Cholera Infantum 60 

Notes on Remedies .' . 75 

External Measures 76 

Chorea 76 

Convulsions 78 

Notes on Remedies 84 

External Measures. . , , , 85 

Coryza 85 

Croup 88 

Tracheotomy in Croup 97 

Notes on Remedies 102 

Cyanosis Febrilis Perniciosa 104 

Dentition 105 

(v) 



VI TABLE OF CONTENTS. 

PAGE 

Diabetes Mellitus 109 

dlarrhosal disorders 110 

Entero-Colitis 137 

Notes on Remedies 140 

Diphtheria 144 

Prophylactic Treatment • 144 

General Treatment. . * . 145 

Local Treatment 156 

Diphtheritic Paralysis 158 

Tracheotomy in Diphtheria •••.... 175 

Notes on Remedies 177 

Internal Remedies 177 

Local Applications 182 

Eczema 186 

Ephemeral Fever 192 

Erysipelas Neonatorum 192 

Erythema 194 

hematoma of the sterno-mastoid 195 

Headaches 195 

Hydrocephalus 197 

Notes on Remedies. , 200 

External Remedies 201 

Hydrocephalus, Spurious 201 

Hysteria 203 

Icterus Neonatorum 205 

Incontinence of Urine 206 

Indigestion 207 

Infantile Paralysis 210 

Infantile Syphilis 213 

Notes on Remedies 220 

Influenza 220 

Intertrigo 221 

Intussusception 222 

Laryngitis (Acute) 227 

Laryngismus Stridulus 228 

Mammary Gland, Enlargement of 231 

Malaria 232 

Mel2ema Neonatorum 234 

Meningitis (Acute) 235 

Meningitis (Tubercular) 238 

Prophylactic Treatment 239 

Noma Pudendi 242 

(Esophagus, Foreign Bodies in 242 

Ophthalmia Neonatorum 243 

Parotitis, or Mumps 245 

Pavor Nocturnus (Night Terrors) 246 

Pemphigus Neonatorum . 249 



TABLE OF CONTENTS. Vll 

PAGE 

Peritonitis 249 

Pertussis 250 

Notes on Remedies 261 

Inhalations 266 

Pleuritis 268 

Notes on Remedies 272 

Pneumonia 272 

Septic Pneumonia , 274 

Prolapsus Ani 280 

Notes on Remedies 281 

Rachitis (Rickets) 282 

Notes on Remedies 287 

Retro-Pharyngeal Abscess 287 

Rheumatism 288 

Rubeola (Measles) 289 

Notes on Remedies 293 

Scarlet Fever 294 

Prophylaxis of Scarlet Fever 294 

Albuminuria and Dropsy 298 

Notes on Remedies 315 

External Measures 319 

Sclerema Neonatorum 320 

Scrofula 320 

Spasm of the Glottis 322 

Sprue , 323 

Stomatitis 323 

Notes on Remedies 326 

Trismus Neomatorum 326 

Notes on Remedies 327 

Tuberculosis of the Abdominal Organs 327 

Typhoid Fever * . 328 

Complications 330 

Vesical Spasms 333 

Vulvitis, Aphthous . . . .• , 334 



GENERAL REMARKS 

ON 

THERAPEUTICS OF CHILDREN. 



DR. EDWARD HENOCH, OF BERLIN. 

This author in his work " Lectures on Diseases of Children " gives 
some very important and valuable points on the therapeutics of infancy 
and childhood. He says that the conditions of life in early childhood 
are of such a nature that even the most rational and faithful treatment 
of its diseases is useless in an extremely large number of cases. Even 
the most persistent study and ripe experience will not save you from 
disappointment in reference to therapeutic results. The enormous 
mortality, especially in the first six months, is explained by two sets of 
causes, the first of which is found in the natural development of the 
child, the second in extrinsic circumstances. While children of the 
upper classes, who are carefully nourished, more readily pass through 
these developmental changes, they are apt to become pathological under 
the adverse circumstances to which the lower classes are subject. The 
foul air of narrow, crowded rooms, the more or less improper food, the 
influence of cold, hunger, the lack of natural care — all these influences 
tend to impede the natural course of development, and to produce the 
harrowing pictures of disease with which we come in contact. Many 
of these unfortunate beings carry with them the seeds of death, and 
die of exhaustion the first few days after birth ; others succumb to 
hereditary syphilis ; the majority become puny on account of persistent 
diarrhoea, or repeated attacks of bronchitis, with enlargement of the 
bronchial glands, which finally leads to cheesy degeneration and gen- 
eral tuberculosis. 

The examination of the urine is very difficult in the new-born and 
2 (17) 



18 DISEASES OF CHILDREN. 

nurslings, as it is always passed into the diapers, and an estimation of 
its quality and color is very uncertain. But in some cases it becomes 
necessary to examine for albumen or sugar, and the urine must there- 
fore be gathered in special vessels (in girls, in well-cleaned sponges 
placed in front of the genitals ; in boys, in condoms or rubber bags 
fastened around the penis), or by the introduction of an elastic catheter. 
"Vigorous, continued crying, which does not excite a coughing spell, 
is a favorable sign in diseases of the respiratory organs, because it 
indicates a comparatively slight degree of irritation of the respiratory 
mucous membrane. Loud crying spells, with vigorous movements of 
the lower limbs, especially flexion on the abdomen, usually, in nurs- 
lings, indicate colic pains. Writing of the atrophic conditions of chil- 
dren^ this author lays great stress upon the most important factor of 
nutrition. If vomiting and diarrhoea are constantly recurring in an 
infant, no time should be lost in securing another nurse. He makes 
the condition of the child his criterion in judging of the suitableness of 
the milk it is receiving, relying but little upon chemical or microscop- 
ical examination. During the first three months, the proportion of 
milk to water should be as 1 to 3, in the second three months as 1 to 2, 
and in the third half and half. After the ninth month, you may give 
two parts of milk to one of water, or undiluted milk ; both the milk 
and water used,, should be first boiled, in order to destroy any fermen- 
tation germs that they may contain. When cow's milk cannot be used, 
he gives the next place to condensed Swiss milk. During the first 
three months, one part of condensed milk is given to twenty-two parts 
of water, from the third to eighth months, one to eighteen, and later 
one to twelve. Oat-meal or barley water may be used as the diluent. 
After the tenth to the twelfth week he recommends Nestle's flour as a 
very suitable article of diet. One tablespoonful may be boiled with 
nine or ten tablespoonfuls of water. Nothing need be expected from 
the use of drugs in the treatment of atrophy, except when complicated 
with diseases of the respiratory organs or intestinal canal. 

DR. ARMAND SEMPLE, OF LONDON. 

This author in his work on "Diseases of Children," gives us some 
valuable points in reference to the 

CLINICAL EXAMINATION OF CHILDREN. 

Inspection. — If the child is asleep : 



CLINICAL EXAMINATION. 19 

Note the attitude, whether the posture is natural or the reverse. 

The color of the face. Is it pale or flushed ? 

The color of the lips. Are they livid or white ? 

The condition of the skin. If it is moist or dry, and whether limited 
to the forehead and head, or is it general ? 

The expression of countenance. Is it natural or indicative of pain ? 

The action of the alse nasi. Are they quiet or twitching. Is there 
any moaning, starting or grinding of the teeth ? 

The respirations. What is their number ? 

Are the eyes staring, closed or partially closed ? The state of the 
fontanelles. If they are open or closed, retracted, distended, or 
strongly pulsating. 

The pulse under two years should vary from 90 to 130, but consist- 
ently with health after three years it is seldom above 100. Although 
not more than 70 it may still be healthy. The absolute number of 
beats is of slight importance ; but a slow pulse in a child is & serious 
indication. The shape and size of the head must be observed, if this 
part is hot or large, or presenting enlarged veins . 

If the eliild is awake : 

Is it smiling or frowning, is it excited or quiet, languid or fretful, 
are the eyes surrounded by a dark circle ? Is there any suffering ? 

An infant in perfect health should sleep 20 hours out of the 24. It 
is, therefore, important to discover if a child's illness began with broken 
rest or sleeplessness. 

Upon stripping a child, the following appearances should be noted : 
the surface of the skin should be mottled, the flesh firm, the skin elastic 
to the touch, and smooth, never flabby, the legs and arms should move 
with freedom. The joints should be examined, whether large, small or 
swollen. The respiration in a child from 1 to 3 years of age should 
be 24 to 36 per minute, and in their character diaphragmatic. The 
chest walls should not recede in an ordinary respiration. Eruptions 
should be looked for, especially around the anus. The stools of an in- 
fant should be yellow, and the motions passed three or four times a day. 
The gums should be examined, whether hot, swollen or otherwise. The 
first incisors should be present by the 7th month, the first molars by 
the 12th, the canines by the 18th, and the second molars by the 20th 
\nonth. 

A child seldom lifts its head from the pillow until about the second 
month ; it is unable to sit erect until the 4th or 5th month. 



20 DISEASES OF CHILDREN. 

The Respirations. — In a child, the respirations vary, per minute, 
from 30 to 50. The actual average in infancy is 39. From 2 months 
to 2 years, the respirations are about 35. From 2 years to 6 years 
the respirations are, during sleep, 18 ; awake, 23. 

From 6 to 12 years, the same. 

When practicable, both the front and back of the thorax should be 
examined ; but the back of the chest in the sick child is the most im- 
portant part to examine, and auscultation should be performed before 
percussion. 

If the back presents no indications of bronchitis or pneumonia, it is 
very improbable that the front of the chest will show any. 

Dullness posteriorly on the right side is a normal physiological state, 
due to abdominal pressure, by which the abdominal viscera, and, upon 
the right side especially, the liver, are pressed upwards. 

The Expression of the Countenance. — The lower part of the face 
suffers chiefly in abdominal disorders, the cheeks are sunken and puck- 
ered, the lips are pale or livid. 

The middle parts of the face are altered by lung and heart affections, 
the nostrils twitching, distended or sharp. There are dark rings under 
the eyes, and a blue circle round the mouth. 

The upper part of the face is mainly affected in cerebral diseases, 
producing contraction of the forehead, knitting of the brow, and pur- 
poseless, rolling, or fixed eyes. In addition to the above signs must be 
noted, pallor or redness, unequal dilatation of the pupils, and ptosis. 

Gesture. — This is often of significance. In abdominal diseases the 
child draws up the legs, and picks at the clothes ; the face is anxious 
and sunken. In cerebral disease, he puts the hand to the head, beats 
the air with uncertainty, rolls the head on the pillow and pulls at his 
hair. 

In severe dyspnoea the child clutches at its throat, or puts the hand 
in the mouth, when the tongue is much furred or when a false mem- 
brane is forming. 

The Cry. — This varies. It is labored or choking in capillary bron- 
chitis or pneumonia. In brain disease it is sharp and shrill ; character- 
istic in acute hydrocephalus (the "hydrocephalic cry"). In laryngitis 
it is metallic or brassy, and in tubercular peritonitis or marasmus it is 
wailing or moaning. Crying for several hours, always indicates one of 
two condition — hunger or ear-ache. A cry which precedes defecation, 



CLINICAL EXAMINATION. 21 

or is accompanied by writhing or wriggling is intestinal. A dry, low, 
peevish cry attending suppressed cough, indicates pneumonia. A 
louder shrill cry upon coughing or moving the child, is an indication of 
pleurisy. In diseases of the alimentary canal, moaning is highly 
characteristic. 

Posture. — In addition to the upright position or orthopnoea, the 
most noticeable position is the u en chien de fusil" the child lying on 
its side, the arms drawn close over the chest and the legs flexed power- 
fully. This position is conspicuous in some cerebral diseases, and in 
the late stages of tubercular meningitis. 

The Evacuations. — In health, an infant's motions should vary in 
color from light yellow to greenish yellow. Their reaction is always 
acid. The odor should be similar to that of sour milk ; but it should 
never be offensive. Its consistency varies considerably within the 
limits of health. 

The Tongue. — A red, hot, dry tongue indicates inflammation of the 
mouth and stomach. A furred tongue, over which white curd is 
spread shows indigestion and intestinal irritation. Aphthae or thrush 
may occur from neglect or starvation ; white fur usually points to fever. 
A flabby, pale tongue, with marked edges, is an indication of great 
weakness. Yellow fur shows long-standing derangement of the stomach 
and liver. A brown tongue points to a low typhus state. In addition 
to the above, must not be forgotten the so-called " strawberry " tongue 
of scarlatina. 

Temperature. — Twenty-four hours after birth the average tempera- 
ture is 100.4° F., and forty-eight hours after it is about 98.6° F. 
During the first few days of life it varies very little from the forego- 
ing. At a later period the average must be considered about 99° F.; 
98° to 99.5° F. is perfectly normal. Some abnormal condition must 
be suspected when it is below 97° F.; or above 100° F. 

The temperature is a more reliable guide than the pulse in young 
children. The thermometer alone will indicate the suspicion of scarlet 
fever, or enteric fever, or some incipient pneumonia or even worms. 
Rigors do not occur in young children, and in these subjects, delirium 
and convulsions to a great extent correspond to the headache and 
rigors of the adult. In typhoid fever, a gradual increase of tempera- 
ture for the first four days, with morning remissions, is diagnostic. In 
tubercle, the evening temperature is as high or may be higher than the 



22 DISEASES OF CHILDREN. 

morning. A steady fall of temperature, toward the evening espe- 
cially, must be considered a very favorable indication in the continued 
fevers, and in inflammations generally, if the general condition of the 
patient corresponds. A fall of temperature, with a rapid pulse, and 
aggravation of the symptoms, indicates danger from exhaustion. A 
sudden rise or fall of temperature always precedes death. 

The Eye. — Strabismus or squinting is a serious symptom. It may 
result from paralysis, reflex irritation or convulsions, but after the sub- 
sidence of the convulsions, the squint may remain for a time or even 
permanently. When squinting is observed in acute hydrocephalus it is 
nearly always a fatal symptom. A large pupil is more common than a 
small one. The latter occurs in sleep, in opium poisoning and in cere- 
bral congestion. Inequality of the pupils occurring in acute diseases is 
always of grave import, but large pupils, if equal in size, are only to be 
considered serious if they are insensible to light. The pupils have been 
noticed to be irregular in children who were suffering from intestinal 
worms. 

The Pulse. — An extremely slow pulse indicates brain disease. The 
following facts should always be borne in mind in connection with 
diseases of children : 

In early childhood, the intensity of the symptoms, bears no relation 
to the existing affection. 

Very intense fever with restlessness, screaming, and convulsions, may 
pass off in 24 hours, not leaving the least trace. 

Copious perspiration is never seen in young children, moisture 
entirely replaces it. 

Fever, in the acute diseases of young children, always exhibits con- 
siderable remissions. 

Fever is almost always intermittent in the chronic diseases of infancy. 

During sleep, the pulse of a child falls from 15 to 20 pulsations. 

The pulse may be raised 15, 30, or even 40 pulsations, by the mus- 
cular movements which accompany convulsions, cough or crying. 

DR. R. L. MOORE. 

This writer tells us in the Journal American Medical Association 
that one of the watchwords in treating diseases of children is " elimina- 
tion." Don't lock up the secretions. Give nature, that grand old 
mother, a chance. Very rarely should opium or any of its preparations 



ALIMENTATION. 23 

or derivatives, be used in the treatment of children. He who abides 
the nearest to this rule will have the best success in treating them. 
Look after them closely. Stand by the small and frequently repeated 
doses of tasteless medicines. Never forget that a sick child is always 
dangerously sick. 

ALIMENTATION OF YOUNQ CHILDREN. 
The following are the conclusions on this subject that were presented 
by the committee appointed for the purpose to the Eleventh Congress 
of the German Physicians' Association {Quarterly Compendium 1883). 

1. The natural food of children — mother's milk — is to be preferred 
above all others. 

2. Only in case of positive contraindication, or non-appearance of 
the milk, should a wet-nurse be employed. 

3. Only in case of impossibility of procuring a wet-nurse, should 
artificial food be employed. 

4. The contraindication against the mother nursing is actual disease 
or a predisposition to disease. 

5. Hereditary syphilis demands the milk of the mother ; that of a 
wet-nurse should only be used with great caution. 

6. Examination of a given specimen of milk furnishes no clue as to 
its value in a given case. 

7. Good cow's milk alone is fit to take the place of woman's milk as 
food for the child. 

8. The quality of good, sweet cow's milk, for a child which must be 
artificially fed, is one of the most important essentials in the hygiene 
of young children. 

9. All children's foods, including Liebig's soup (food), on account 
of the large quantity of starch contained in them, are unfit for children 
during the first month. 

MENTAL DISEASE IN SCHOOL CHILDREN. 
In the Boston Medical and Surgical Journal, 1882, Dr. S. G. 
Stebbins says that mental diseases, such as are produced by overtaxa- 
tion of the brain are by no means rare in schools. A business man 
may apply to you suffering from pain and a sense of fullness and un- 
easiness in the head, more or less dizziness, with occasional attacks of 
vertigo, general uneasiness and inability to sleep or to fix his attention 
upon one subject for any length of time, and you then declare him to 



21 DISEASES OF CHILDREN. 

be a victim of cerebral hyperemia, which, long continued, leads on to 
congestion, effusion and eventually death, or, what is worse, a life of 
insanity. The same conditions and results often obtain among scholars 
who are obliged to tax their brains beyond their normal powers of en- 
durance, excepting that insanity, perhaps, rarely results from over-study 
in early life. He relates the cases of three school children, who died 
of disease of the brain from over-study and worry, neither of whom 
were over twelve years of age. He believes that the practice of fre- 
quent and written examinations is a trying ordeal for young pupils, and 
this system of forcing the youthful mind, tells upon the nervous system, 
and seriously, in many cases. For this reason, he observes, that the 
practice of stimulating young persons to excessive work, by offering 
prizes is to be greatly deprecated. 

MALINGERING IN CHILDREN. 

It is of the highest importance for physicians to understand that 
simulation and dissimulation are characteristics of certain temperaments 
at very early ages. Deliberate and persistent malingering is quite pos- 
sible within the first decade of life. A striking instance in point is 
given in the Word. Med. Archiv., 1881. 

A girl seven years old, daughter of a laboring man, complained of 
pain in the knees and tendons of the legs, and lay in bed more than 
two months with her thighs drawn close up to the abdomen. After 
this, the child, who lived at a distance, was seen for the first time by 
Dr. Malmgren, and examined, with the result that no disease could be 
detected. The legs were now forcibly extended, and a bandage was 
applied. The next day, the child, being tired of this, declared that 
she could lie without being bent up. The parents took off the bandage ; 
she lay straight, but said that she could neither walk nor stand on her 
legs. In this state her parents allowed her to lie six or seven weeks, 
in the belief that she was paralyzed. She now, however, conceived 
the idea of counterfeiting dumbness ; she could no longer be induced 
to speak. Dr. Malmgren endeavored, by means of pinching and prick- 
ing and the induction-apparatus, to make her utter a sound ; but not 
until she was told that she would be removed to his house, did she 
recover her speech and confess the deception. 

DR. JULES SIMON, OF PARIS. 

This author in the Gazette De% ffojritaux, 1881, gives some val- 



CINCHONA IN CHILDHOOD. 25. 

uable hints with reference to the administration of cinchona to chil- 
dren. It is seldom, he observes, that powdered bark is administered 
to children ; but still it is sometimes given, in cafe noir, after the age 
of four or five, in quantities of 30 to 45 grains daily. For his own 
part, he prefers 15 to 30 grains daily of the soft extract for children 
when more than two years old. Before that age it causes indigestion, 
as does also the vinum cinchonse. Even the syrup can scarcely be 
borne while the child is still suckling. After the second year, the 
vinum is a very good medicine — that is, on the condition that it is pre- 
scribed properly. We may often see pale, anaemic little girls, for 
whom bark wine, iron, or phosphate of lime, etc., has been prescribed, 
and has done more harm than good. Certainly for the first few days 
a dessertspoonful of cinchona wine given before a meal (as it is gener- 
all ordered) will produce a stimulus and a better appetite and tone ; 
but the improvement is only temporary, and we soon find that the 
appetite is lost again, pains of the head supervening, and the child be- 
coming nervous, etc. Why is the improvement of so short duration, 
and more apparent than real ? Owing to a slight precaution being for- 
gotten — the dilution of the cinchona wine with a little water. So 
diluted, and administered immediately before the meal, it will cause no 
inconvenience. Still, if, in spite of the addition of a small quantity of 
water, dyspepsia and headache should still supervene, or if constipation 
should occur, the cinchona should be suspended for a time. This ad- 
dition of water to the wine is of very great importance, as is the sus- 
pension of the medicine when any great susceptibility exists ; and the 
observation holds good also with regard to quinine wine. Syrup of 
cinchona is a tonic which may be given to a child after its fifteenth 
month, and the alcoholic tincture may be begun with after the second 
year — associating it advantageously with bitter preparations. The 
action of cinchona upon the alimentary canal is complex, giving tone, 
appetite, and slight constipation when properly administered, and in- 
ducing dyspepsia when given badly. It renders the pulse stronger, 
fuller, and more regular, and aids the development of the blood 
globules. It acts favorably on the nervous system when properly pre- 
scribed, but only does mischief when the precautions mentioned are 
not observed — producing stomachal vertigo and an irritability of dis- 
position. Cinchona also has the property of diminishing the urinary 
secretion, and is contra-indicated in cases in which this is deficient. 



26 DISEASES OF CHILDREN. 

Of the salts of quinia, the sulphate is the only one Dr. Simon em- 
ploys, giving it in powder in cafe noir, or, when the child is old 
enough, in a wafer. Owing to its bitterness, it may be given in sil- 
vered pills of J of a grain each, which can be concealed in preserve. 
When the child refuses H thus, it may be given in solution, facilitating 
its tolerance and preventing griping by a little opium, which does not 
interfere with the effect of the quinine. It is best given immediately 
before meals. Quinine may also be given advantageously in an enema 
in rather larger doses and combined with a drop of laudanum. Used 
externally, in the form of an ointment made up with equal parts of 
lard, the quinia is only found in the urine by the third day in children 
above two years of age, and somewhat earlier in those who are younger. 

SCHOOL HYGIENE. 

Dr. Charles J. Lundy, of Detroit, read a paper on this subject be- 
fore the American Public Health Association (1884) in which he dwelt 
on the evils that accrue to young children from defective school hygiene 
and summed up his paper as follows : 

1. Avoid the cramming process in education, and the nervous excite- 
ment due to the spirit of rivalry. 

2. Reduce the number of subjects in the curriculum, and shorten the 
periods of study. 

3. Ventilate the school-rooms in accordance with the most approved 
methods. 

4. Regulate the temperature of the school-room — an atmosphere 
which is too warm debilitates the system. 

5. Provide properly constructed and arranged seats and desks. 

6. Instruct pupils to sit erect, and to hold the book or paper at least 
twelve inches from the eye. 

7. Provide highly myopic pupils with proper spectacles, which will 
enable them to read at the natural distance of twelve inches. 

8. Furnish pupils with well-printed books. 

9. Furnish abundance of light, without producing glare. Let it come 
from the left side if the room is narrow, from both sides if the room is 
wide. 

10. Provide for the physical education of school children, and teach 
them the importance of out-door exercise. 



NATURAL MINERAL WATERS. 27 

DR. THOMAS H. FENTON, OF PHILADELPHIA. 

This physician read a very interesting paper on this subject before 
the Pennsylvania State Medical Society (1884) in which he said that 
two hundred and twelve thousand children attended the public schools 
of Philadelphia in 1880. The value of the school plant was $6,179,- 
750. The location of many buildings was faulty as to light and air. 
Ventilation especially is defective, no provision being made for the exit 
of foul air beyond the opening of the windows. Special care has been 
taken to ascertain the truth of this point by accurate and careful tests. 
The next defect noted was that of drainage, and the poor arrangement, 
especially of water closets, was considered. 

Next came the important point of desks and seats, and the bad effect 
of careless arrangement of these upon the spine, the chest, and the eyes, 
was dwelt on at length. The prevalence of myopia was stated, and the 
difficulty of managing it without proper arrangements for holding books, 
etc., before the eyes of the children at proper distances was denned. 
The plan of allowing the light to fall directly upon the faces of the 
pupils was condemned, and the lack of proper illumination of black- 
boards was referred to. The color of walls, ceilings, and the paper of 
books, was stated to be very important. 

DR. JOHN M. KEATING, OF PHILADELPHIA. 

This author, in the Archives of Pediatrics, 1884, calls attention to 
the advantages to be derived from the use of natural mineral waters 
in the diseases of children. He has used largely and with success the 
Buffalo Lithia water, Spring No. 2, and Farmville Lithia Water, with 
infants of the tenderest age ; he has found them especially valuable in 
the eruptive fevers, where there is much thirst and scanty, high-colored 
urine. A stone jar of it should be kept on hand, and the water used 
ad libitum, when the child is thirsty, or it may be used to dilute the 
food. In those cases Avhere there is constipation, the alkaline saline 
waters, as Saratoga Seltzer, may be used instead. As alteratives in 
scrofula, the saline waters are most useful. The best way to administer 
them to children is by the bath. In children's practice the most valu- 
able of this class is sea water. The baths should be administered daily, 
allowing the child to remain in the water ten or fifteen minutes, and it 
is better for the water to be about blood heat. When the sea shore is 
inaccessible or in winter, the prepared salt can be obtained and will 



28 



DISEASES OF CHILDREN. 



answer almost as well. Of this, about one ounce to the quart of water 
will represent the strength of sea water. Sulphur waters, when fresh, 
are most useful as baths, especially in syphilitic cases ; after exposure to 
the air they can be used internally in rickets with inherited syphilis. 
Asa rule sulphur waters have a tendency to constipate, but the saline 
sulphur waters are, of course, cathartic. In obstinate constipation an 
infant may be given a tablespoonful or two of Bedford water several 
times daily. As an alterative, for constant use, the water of Sharon 
Springs is probably the best. For the rheumatic diathesis, the water 
of Richfield Springs, New York, is very good, and probably many of 
those distressing cases of organic disease of the heart, the result of 
rheumatism in early life, could be avoided by proper use of this excel- 
lent water before it is too late. 

In syphilis, or rickets, the iodine spring of the Bath Sulphur Springs, 
of West Virginia would be useful. There is no reason why children 
should not become soon accustomed to the taste of these sulphur waters, 
and until then the water can be exposed to the air. In infants the 
baths would be advantageous. The water of the Hot Sulphur Springs, 
Virginia, is said to be especially useful in allaying irritation of the mu- 
cous membrance, especially of the lungs, or in chronic bronchitis. 
These calcic-sulphur waters are probably more valuable in diseases of 
adults, owing to their special action upon the bladder. 

The chalybeate sulphur waters, as Minnequa Springs, Pennsylvania, 
are recommended in cases of anaemia following rheumatism or in mild 
syphilitic affections of the skin. Of the saline-sulphur waters, useful 
in eczema, the rheumatic diathesis, and where there is a syphilitic taint, 
the author mentions the Blue Lick, of Kentucky ; the Lafayette, the 
Indian Spring, the West Baden, the French Lick, of Indiana ; the 
Blount Springs, of Alabama ; and the Green Cove Springs, of Florida. 
The chalybeate springs are represented by the Rawley Springs, of Vir- 
ginia, or of Schooley's Mountain, New Jersey. There are those that 
are saline, most valuable in cases where saline waters are demanded, as 
in scrofula ; there are those that are alkaline, useful in cases of weak 
digestion, and dropsy from kidney disease, with anaemia. Of the former, 
the Ocean Spring, of Mississippi, is an example ; of the latter, the Bailey 
Springs, of Alabama. The alum waters, which also contain iron; are 
valuable in the scrofulous and tubercular diathesis. The Oak Orchard 
Acid Springs of New York contain free sulphuric acid. They are use- 






NATURAL MINERAL WATERS. 29 

ful in cases of atonic conditions of the bowels, without congestion of 
the mucous membrane, in relaxation of the mucous membrane in whoop- 
ing-cough or as a stimulant to that of the stomach, following summer 
complaints, etc. They can be taken internally in small quantities. They 
are most useful as baths, especially in bone scrofula, in discharges from 
the ears or nose, and in chronic eczema. The Rockbridge Alum Springs 
of Virginia are a type of this class. The Bath Alum Springs of Vir- 
ginia are probably the best, as they contain a larger proportion of iron. 
The Alum Springs of Cresson are said to be valuable. 

The calcic waters are very useful in the rickety diathesis. They are 
tasteless, and can be used freely as ordinary drinking-water. He has 
frequently required pregnant women, who have previously borne child- 
ren deficient in bone development, to drink these waters. Of this class, 
Gettysburg water is a type — it is an alkaline calcic water. The Alle- 
gheny Springs, of West Virginia, would also be valuable, especially 
when a slight purgative action is required, as they have an excess of sul- 
phate of lime. The Sweet Springs, of West Virginia, contain a large 
amount of the carbonate of lime. Bethesda water also belongs to this 
class. 

To obtain the alterative action, which is the one we most frequently 
require, will necessitate the constant and prolonged use of the water 
selected, either internally or by bath, as the case demands. For bath- 
ing purposes, it may require a sojourn at the spring selected ; and for 
cutaneous affections, or scrofulous discharges and rheumatic joint 
troubles, this may be imperative. 

DR. HUEBNER, OF FRANCE. 

In the Rev. Mens, des Mai. de FJEJ., 1884, this author observes that 
cooling of the thoracic region produces a very noticeable effect upon the 
entire organism. His method consists in the use of water at 16° C, in 
which a large cloth is dipped, and then is carefully wrung out. It is 
then to be spread upon the surface of the body, covered with flannel, 
and changed every half hour until the temperature is sufficiently low. 
A temperature ranging near 40° C. is an indication for this treatment. 
In some cases it will be well to envelop the entire body with the wet 
cloth, but in very young children it would not be advisable. If it is de- 
sired to produce heat and sweating by this means, mustard should be 
added to the water, and the pack should be retained an hour and a half. 



60 DISEASES OF CHILDREN. 

DR. POLITZER, OF VIENNA. 

This distinguished authority, who has had forty years' experience 
with the public Institute for Sick Children, at Vienna, calls attention 
in Jahrb, f. Kinderh, 1884, to the value of certain isolated symptoms 
in making the diagnosis of many of the diseases of children. 

1. One which is likely to attract attention at once, is a strongly 
pronounced nasal or palatal resonance in a child's cry, and this is, in 
many cases, the first symptom which should lead to a timely diagnosis 
of retro-pharyngeal abscess. The symptom is present, however, in 
some other affections, for example, in the ozcena of congenital syphilis, 
and in hypertrophy of the tonsils. 

2. A greatly prolonged and loud sounding expiratory act, with nor- 
mal inspiration and complete absence of asphyxia. Upon this symptom 
alone the author is willing to base a diagnosis of chorea major. 

3. A sighing inspiration which is continuous, and seems to originate 
from the upper portion of the thorax. It has not been sufficiently con- 
sidered by the profession, bearing in mind its importance with reference 
to diagnosis, and prognosis, and also to treatment. It indicates the 
beginning of heart weakness and paralysis, and sometimes a develop- 
ing acute fatty degeneration of the heart. 

4. A strongly pronounced diaphragmatic expiratory act, shrill and 
penetrating in character. This is spoken of as strongly contrasted to 
the preceding symptom, but equally valuable in diagnosticating the 
bronchial asthma of childhood. 

5. The occurrence of pauses between the end of expiration, and re- 
curring inspiration. This might be taken as a symptom of croup, but in 
most cases the probabilities are more favorable to the presence of 
laryngeal catarrh of a pronounced type. Associated with this symptom 
as an important condition, is the spasmodic catarrhal stenosis, with its 
accompanying sub-mucous oedema. 

6. Continuous stridulous respiration from the time of birth. This is 
not unfrequently seen, but is often without important significance, and 
is supposed by the author to be due to some fault of innervation, espe- 
cially with respect to the inhibitory fibres of the vagus. 

7 . A series of individual symptoms is next referred to which have re- 
ference mainly to the diagnosis of diseases of the brain. The first of 
these is a very pronounced drowsiness, which is unattended by fever or 
any other noticeable disturbance, and which lasts some time. When oc- 



SPECIAL SYMPTOMS. 31 

curing in children who are pale, unusually quiet and apathetic, it is very 
often an initial symptom of basilar meningitis. A second symptom of 
this series is a resistant and non-compressible anterior fontanelle which 
is considerably elevated above its ordinary level. It is an important 
and too little appreciated symptom, for it is present in cerebro-spinal, 
and verticalar meningitis, in acute, simple and complicating hydro- 
cephalus, with tumors of the brain, and in intermeningeal apoplexy of 
infants. It is a noteworthy symptom too in fevers, and in various in- 
flammatory conditions, but its especial value consists in its indicating 
that there is independent disease of the brain aside from any other con- 
current processes. The deeply-depressed anterior fontanelle with which 
is almost always associated a sunken condition of the eyeballs, is indica- 
tive of inanition, and diminution of the volume of the blood. The third 
symptom of this series consists in a remarkably slow movement of the 
eyeballs, a staring, vacant expression, and slow, infrequent moving of 
the lids. It is considered by the author as an important indication of 
the beginning of basilar meningitis. 

8. Another series of symptoms may also be noted with advantage in 
respect to the crying of children. The first of these is a violent, pene- 
trating cry lasting two or three minutes, accompanied with a most anx- 
ious expression of countenance, and occurring an hour or an hour and a 
half after the child has gone to sleep. It is an indication of what is 
commonly known as "night terrors," and is very apt to occur among 
genemic and irritable children. Again there is a cry which lasts five or 
ten minutes, which comes periodically both by day and by night, and 
may indicate colic or dyspepsia, but it is more likely to be caused by 
spasmodic action of the bladder, especially if it be observed that strang- 
ling accompanies it. Another cry seems to be associated with fear 
whenever the act of defecation takes place. In such cases obstinate 
constipation is very likely to be present and fissure of the anus will 
often be found to be a sufficient cause. Another severe, painful, con- 
tinuous cry, with restlessness of the head upon the pillow, and frequent 
grasping of the head serves to indicate an otalgia, or an -otitis externa 
and media. Another variety lasts for days and weeks, is exaggerated 
by touching and movement of the limbs, and is associated with paroxysms 
of sweating and fever. The author looks upon this as indication of 
acute general rachitis. Still another cry is associated with constant 
sleeplessness. This may be one of the phenomena of congenital syphi- 



32 DISEASES OF CHILDREN. 

lis ; but it is more likely to proceed from errors in diet, and in still 
other cases it is due to the viciousness of nurses. Finally there is a 
form of cry "which is kept up day and night, which is associated with a 
history of exhausting discharges, and consequent thickening of the 
blood. 

9. A final series of symptoms includes some which are not noticed by 
the parents of the child, or not as early as would be desirable for the 
child's interests. First is mentioned the peculiar physiognomy of con- 
genital syphilis. Second is a decided falling together of the nostrils, 
with total absence of motion in them during inspiration, and significant 
narrowing of the nasal cavities. This is an indication of hypertrophy of 
the tonsils of a decided type. Next, a disinclination or inability to 
move, on the part of certain children, is referred to, which is associated 
with pronounced weakness, and all of which is out of proportion to the 
apparent gravity of the child's disease. The symptoms indicate, how- 
ever, an approaching or existing spinal paralysis. Weakened power of 
hearing sometimes indicates the presence of circumscribed meningitis. 
Depression of the psychical activity after certain brain affections, in 
small children, may be an indication of the beginning of acquired idiocy. 
An indication of rachitis is sometimes seen in the delayed ossification of 
the cranial bones. An anxious awkward posturing in walking, sitting, 
rising and bending, and, in those who cannot walk, a painful contracting 
of the facial muscles, is said to be a valuable sign of the beginning of 
spondylitis. A constant vomitiRg, lasting for several weeks, occurring 
in children with closed fontanelles, and large cranial circumference, in- 
dicates a chronic hydrocephalus which has taken an acute form. Finally, 
an attack of convulsions may occur, which is the primary indication that 
the child has epilepsy. In such a case it is important to know as many 
symptoms as possible before rendering a positive diagnosis ; hence all 
the points in relation to the convulsions should be taken into considera- 
tion before a diagnosis of epilepsy is given. 

MILK DIET IN CHILDHOOD. 

DR. CAMMAX, OF NEW YORK. 

This author presents some interesting statistics in the N~. Y. Med- 
ical Journal in support of his protest against the introduction of meat 
into the dietary of children. Among the evil results of the use of 
meat bv children are mentioned feverishness, fretfulness, stomach and 



MILK DIET. 33 

intestinal disorders, and the formation of the neurotic diathesis. In the 
Orphans' Home and Asylum of New York, for the past twenty-five 
years meat has been excluded from the dietary, and milk has been one 
of the chief articles of food for children from three to eight years of 
age. Twenty deaths occurred in twenty -four years, the average num- 
ber of inmates for almost the entire period being about 145. In 1865, 
when meat was, for a short time, added to the dietary, a death oc- 
curred from dysentery, and another from cholera, the only deaths oc- 
curring from disorders of the digestive apparatus in a history of 
twenty-five years. During this year, the cases of digestive derange- 
ments were three hundred per cent, more than in the previous year. 

ANAESTHETICS IN CHILDREN. 

M. Bouchut recommends (Gazette des Hopitaux, 1880) the 'use 
of chloral as an anaesthetic in minor operations upon children. The 
dose, fifteen, thirty, or forty-five grains, as the case may be, is given 
in tour ounces of water, well sweetened, the whole being taken at 
once. Half an hour afterwards the child sleeps, and in one hour, is 
totally insensible. This sleep lasts from three to six hours, and the 
child awakens as fresh as if from natural sleep. Once insensibility ar- 
rives, a great number of operations can be performed, such as extrac- 
tion of teeth, destruction of erectile tumors by caustics, application of 
Vienna paste, opening of abscesses, thoracentesis, redressing of mal- 
formed limbs, anchylosis, etc., without any other inconvenience than 
that of leaving the children to sleep off the effects of the chloral. 

M. Bouchut asserts that he has administered this anaesthetic over 
ten thousand times at the hospital QHopital des Enf antes Malades~), 
and never had an accident; where the stomach rejects the chloral 
(which is very rare in children), a suppository with the required dose 
is given, and when it has melted sleep comes on. M. Bouchut, how- 
ever, is not much in favor of this mode, as chloral, he has found, irri- 
tates the rectum after the third or fourth time. Although chloral is so 
well tolerated in the child, it is far from it in the adult. M. Bouchut 
never could succeed in giving a dose large enough to produce insensi 
bility, as when sixty grains were administered it was rejected at once 
"If the employment of this anaesthetic, " says M. Bouchut, "were at 
tended with any danger, it should be abandoned, but as I have already 
stated, there is none whatever." 
3 



^"^™» 



84 DISEASES OF CHILDREN. 

DRS. PENZOLDT AND SARTORIUS, OF GERMANY. 

These gentlemen have made a number of trials of antipyrin in the 
treatment of children's diseases, and report the conclusions in the Ber- 
liner Klinische Wochenschrift, 1884: 

1. Antipyrin is to be regarded as a very effectual remedy in the 
pyretic diseases of childhood. 

2. In suitable dose it lowers the temperature several degrees, and 
the effects continue for several hours. 

3. The pulse-rate is never reduced in a degree corresponding to the 
fall of temperature. 

4. The effect upon the general condition is usually good. 

5. The only disturbance that it ever causes is occasional vomiting. 
When this occurs the remedy may be given by the rectum. 

6. Anp'tipyrin should be given in three doses at intervals of an hour. 
Each dose should consist of as many decigrammes (one and a half grain) 
as the child has lived years. If this dose is insufficient, as may often 
be the case in small children, it should be increased a decigramme at a 
time until the desired effect is obtained. When administered by the 
rectum, a single dose of from three to six times as many decigrammes 
as the child counts years may be given. 

7. When the use of the drug has been long continued, the organism 
seems at times to become tolerant, and then the dose must be increased 
cautiously. 

PROFESSOR LEDAMENDA. 

This author publishes the following valuable aphorisms on the man- 
agement of diseases of children in _£7 Dictamen, 1884: 

1. Children are like the mob: they always complain with reason, 
although they cannot give the reason why they complain. 

2. Always look at the lips of a pale and sickly child ; if they are 
of a deep red color, beware of prescribing tonics internally. At the 
outset you will congratulate yourself; but in the long run you will 
repent of having employed them. 

3. As a general rule, a sad child has an encephalic lesion ; a furious 
child an abdominal one ; a soporific child has both, though indistinctly 
defined. 

4. An attendance on children produces in the mind of an observant 
physician the conviction that the half, at least, of adult transgressors 
are so through morbid abdominal influences. 



VALUABLE APHORISMS. 35 

5. A sunny living-room, a clear skin, and an ounce of castor oil in 
the cupboard — these are the three great points of infantile hygiene. 

6. To dispute the clinical value of tracheotomy in croup is a waste 
of time to no good purpose. Croup or no croup, if there be a positive 
obstruction to respiration in the larynx, it is but according to reason to 
open a way for sublaryngeal respiration. In the days of more knowl- 
edge and less nonsense, tracheotomy will be ranked among the minor 
surgical operations. 

7. In dentition it is not the direct or eruptive pressure, but the 
lateral pressure of all the teeth together, that is most dangerous. It is 
from this that so many cerebral symptoms appear which can in no way 
be relieved by incisions in the gums. The only recourse against the 
dangers of this transverse pressure is to give the child more nourishment, 
in the hope that, as the general condition is bettered, the local condition 
will also be improved. 

8. If the incisors of the first dentition are serrated, it is bad, but, if 
those of the second formation are the same, it is worse. It foretells a 
number of lesions, arising from deficiency of mineral salts in the 
tissues. There is only one exception, and it is an important one. 
When the serrated incisors are seen in strong children in whom the 
fontanelles have closed early, it is a sign of a robust constitution. 
Instead of a number of small and sharp indentations, there are a few 
large blunt ones. 

9. To regard the eruption of the teeth as the sole factor in the gen- 
eral process known as the first dentition, is to perpetuate a sort of 
medical synecdoche. Children get their first teeth because they are at 
the same time getting a second stomach, and second intestines. 

10. The body of a child possesses such a degree of " acoustic trans- 
parency," that, in case of necessity or convenience, auscultation may 
be practiced with the hand, converting it into a telephone, which will 
reveal as much to the physician as even his ear could do. 

11. In practice it is well to distinguish with precision a case in 
which disease is due to lumbricoides, from one in which lumbricoides are 
due to the disease ; for in the former case anthelmintics are of service, 
but in the latter they do harm. 

12. Since, until the child is able to talk clearly, his relations with 
the physician are purely objective, it is very necessary that we should 
study as carefully as do the veterinarians, the exact correspondence be- 
tween the lesions and the expressions of the patient. 



36 DISEASES OF CHILDREN. 

13. If you wish to cure rapidly and well, joint-diseases in infants, 
you must treat them as you would a conflagration— douches, douches, 
and more douches, until you have succeeded in extinguishing them. 

14. The entire system of the moral relation between children and 
adults should be changed. To speak to them incorrectly, merely be- 
cause they cannot pronounce well ; to excite their fears, and to arouse 
their weird imaginations, simply because they are easily frightened 
and impressionable ; to stimulate their vanity because they are natur- 
ally inclined to be vain — these and other similar actions are not only 
wrongs, but absurd. 

COMBATING FEVER IN YOUNG CHILDREN. 

It is often difficult, and in fact not without danger, to administer an 
efficient febrifuge to young children. In such cases the administration 
of sulphate of quinine by inoculation offers many advantages. The 
absorption of the salt is rendered possible by the extremely thin epider- 
mis in very young children. The following unguent will be found effi- 
cient : 

1. R. Quinise bisulph. gr. xxx 

Camphorse, gr. xv 

Unguent simpl., ^vj. M 

A small quantity may be rubbed in over the groin or in the axilla. 

DR. R. L. MOORE, OF MINNESOTA, 

Considers that a large portion of the ailments of children are simply 
some form of irritation of the digestive apparatus or of the organs of 
respiration. He advocates the use of small and frequently repeated 
doses ot tasteless medicines. He considers that opium and its deriva- 
tives should rarely, if ever, be given to children, but he regards aconite, 
belladonna, ipecacuanha and mercury with chalk, in small and fre- 
quently repeated doses, as the most valuable drugs in the therapeutics 
of childhood. 

DR. W. J. CRAIGEN, OF MARYLAND. 

This author strongly advocates, in the Medical and Surgical Re- 
porter, 1880, a new, and he thinks an improved, method of treating the 
newly -born child. 1. It is not washed. 2. It is not dressed. 3. It 
is not fed. 4. It is not bandaged. 5. Its umbilical cord is not com- 
pressed. The washing is apt to cause chilling, from the evaporation of 



TREATMENT OF THE NEWLY-BORN. 37 

water from the surface. The dressing is usually of such a nature as to 
bind, constrict and overheat the child. Our author asks whether it is 
not probable that this exposure to cold and chilling of the body is the 
initial or starting point of that numerous train of evils that cause such 
fearful infant mortality ? Does not the absurd cramming of improper 
articles into the tender infant's delicate stomach produce irritation, indi- 
gestion, flatulence, pain, cramp, colic, spasms, etc. ? According to this 
writer, as soon as the child is expelled from the mother, it is placed on 
its right side, in a comfortable position for breathing, and kept well 
under the bed-clothes until the cord ceases to pulsate. The cord is 
then nicked off slowly, with a pair of dull scissors, and caught close to 
the abdomen, between the thumb and index finger of the left hand, 
while the blood and gelatine are squeezed out with the thumb and index 
finger of the right hand, and a ligature is thrown around it. Beware 
of a thick, dense, hard, unyielding cord, from which nothing can be 
pressed, for as soon as desiccation relieves the contriction of the liga- 
ture, the child may bleed io death. After ligating the cord, a coating 
of fresh, soft lard is quickly applied to the whole surface of the child, 
except the face, which latter is to be wiped off with a damp cloth. A 
napkin is applied about the hips, and it is quickly slipped into a soft, 
loose flannel gown, enveloped in a proper blanket, and laid in some com- 
fortable place. It is to have nothing except what it gets from its 
mother's breasts. After twenty-four to thirty-six hours it can receive 
its first ablution. Should there be colic, he gives, 

2. R . Magnesii ust., gr. xx 

Pulv. rhei, gr. x 

01. anisi, gtt. x. M. 

S. — Dose from three to five grains. 

ARTIFICIAL FEEDING OF INFANTS. 
DR. ARTHUR V. MEIGS, OF PHILADELPHIA, 

In the Medical News, 1883, describes a new food, with which he 
states that he has obtained very good success. It consists of two parts 
of cream, one of milk, two of lime water, and three parts of a solution 
of milk sugar of the strength of 17} drachms to the pint of water. 
The millk to be used should be good ordinary cow's milk, and the 
cream, such as is usually sold in cities, and not too rich, containing 
about 16 or 17 per cent, of fat. The quantity of this food taken by a 
new-born infant, should be two or three fluid ounces every two hours. 



38 DISEASES OF CHILDREN. 

The best way to prepare and use this food, is to order five or six 
packages of milk sugar, containing 17 f drachms each ; the contents of 
one of these to be dissolved in a pint of water ; and each time the 
child is to be fed, let these be mixed together and then warmed, three 
tablespoonfuls of the sugar solution, two of lime water, two of cream 
and one of milk. This makes about a gill, and as much of it as the 
child does not take should be thrown out, and a fresh mixture made for 
the next feeding. The solution of sugar should be kept in a cool 
place, and at once thrown away if it sours, as occurs if kept more than 
a day or two in warm water. The dry sugar keeps indefinitely, and 
is easily dissolved in warm water. A pint bottle should be kept for 
the purpose of containing the solution, to serve also as a measure of 
the quantity of water to be used with each package dissolved, and also 
to save further measuring. 

PROFESSOR ALBERT R. LEEDS, OF NEW JERSEY. 

As corroborative of the recommendation of Dr. Meigs, it is valuable 
to have the following conclusions of Professor Leeds, which he pre- 
sented to the College of Physicians of Philadelphia, 1883: 

1. Cow's is in no sense a substitute for a woman's milk. 

2. Attenuation with water alone is inadequate, and chemical meta- 
morphosis, or, mechanically, the addition of some inert attenuant, is re- 
quired, in order to permit of the ready digestibility of cow's milk by 
infants. 

3. The utility of manufactured infant's food is to act as such atten- 
uants, and as such they take the place of the simple barley and oatmeal 
water, the sugar, cream, baked cracker, arrowroot, etc., etc., used in 
former times. 

4. The results of both chemical and physiological analysis are op- 
posed to any but a sparing use of preparations containing large per- 
centages of starch. 

5. it is eminently probable that besides acting as attenuants, the 
matters extracted in the preparation of barley and oatmeal water, 
and still more the soluble albuminoid extractives obtained at ordinary 
temperatures (whereby coagulation is prevented), by Liebig's pro- 
cess, have a great independent value of their own. For this reason, 
instead of employing starch, gum, gelatine, sugar, etc., the use of a 
natural cereal extractive, containing saccharine and gummy matters and 



ARTIFICIAL FEEDING. 39 

soluble albuminoids as well, such as our great and inspired teacher 
Liebig himself advocated, is in accordance with the developements of 
science since his time. 

6. The use of a food made up of equal parts of milk, cream, lime- 
water, and weak arrowroot water, as practiced for years by the late 
Dr. J. Forsyth Meigs, and recently advocated by his son, Dr. Arthur 
V. Meigs, is sustained by theory, analysis, and practice. It provides 
for the increase of fat to an amount comparable to that contained in 
human milk. It adds alkali to permanent reaction, and to convert 
caseine into soluble albuminates. It adds a little bland attenuant. 
And, if, in addition, the amount of milk-sugar were raised, and instead 
of arrowroot water, barley or oatmeal water were substituted, as the 
case demanded, it would approach, it appears to me, still more nearly 
to the conditions required. 

7. The perfect solution of the present problem is to be found in the 
modification of cow's milk by chemical processes, so as to make it 
physiologically equivalent to human milk. The nature of these pro- 
cesses, and the results to be obtained, are at present so nearly wrought 
out, that there is good ground for believing that such a solution of this 
problem is not far distant in the future. 

ROBERT FARQUHARSON, M. D., F. R. C. P., LONDON. 

Understanding by " children," those more than one year old, this 
writer (British Medical Journal, Nov., 1877,) points out that it is a 
common error of the text-books to teach that they require much 
smaller doses of most of our active drugs than adults. This is in most 
instances an error, and a material one, as it leads to inefficient medica- 
tion. Children do not present in anything like the same degree, the 
special peculiarities of idiosyncrasy ; the effects of medicines are pretty 
constant in their case, and we may generally anticipate the satisfaction 
of finding that our remedy has acted as we wished, and without any of 
that excess or eccentricity of action which too often brings undeserved 
discredit on the medical man. 

Dr. F. is willing to confirm the usual opinion of the dangers of 
opium in very early childhood, but those within the period of life 
selected for consideration can bear moderate quantities, and chloral 
seems always well borne." For instance, he had under treatment a 
little rickety girl suffering from recurring attacks of laryngismus 



40 DISEASES OF CHILDREN. 

stridulus, to whom 3J grains were given with benefit thrice daily. 
The same patient took 10, and finally 15 grains of bromide of potassium, 
before any beneficial effect was attained; he has always observed that 
this drug is well taken by children. Twenty and thirty grains have 
been no uncommon dose to reach in patients from eight to ten, suffer- 
ing from epileptic seizures, and in them he has never observed any 
symptoms of bromism. The opposite seems to hold good of iodide of 
potassium, for he has several times seen papular and petechial erup- 
tions produced by 1-grain doses of this drug. 

Arsenic is usually well taken. He should have no hesitation in or- 
dering 5 minims of Fower's solution for a child six years old. Ten 
minims have been occasionally ordered. "When physiological symp- 
toms present themselves, as they sometimes do, it is important to know 
that they do not assume the usually described type, and that vomiting 
is the most usual symptom. He has seen this follow a single 1-minim 
dose ; more rarely we meet with a red and irritable tongue, dry lips, 
injected eyes, and abdominal pain ; girls being, contrary to the state- 
ment of Ringer, more susceptible to the overaction of the drug than 
boys. 

Prussie acid may be pretty freely prescribed, and he has given 
nearly 2 minims to a child of two years, with some slight benefit, for 
pertussis ; and at the age of seven, he has given nearly 3 minims for 
the successful arrest of sickness. 

We know that emetics must be given in very full doses. The intes- 
tinal canal of young children seems strangely insusceptible to the action 
of purgatives, and large quantities must be given before satisfactory 
action is attained. 

Belladonna is a drug which can be borne by children in doses fully 
as large as given to an adult. 

J. MILNER FORTHERGILL, M. D., LONDON. 

This experienced therapeutist points out that owing to the impressi- 
bility of the nervous system in children, depressants should only be 
given for but short periods in acute disease. Again, many sick chil- 
dren have ravenous appetites, and the more they eat, the more quickly 
they perish from inanition, in consequence of overloading the already 
weakened digestive powers. Diarrhoea is, especially in children, a 
natural effort to remove indigestible masses, and if checked with astrin- 



THERAPEUTIC MEASURES. 41 

gents, frequently leads to enteritis. A form of diarrhoea with green 
stools is brought about by over-suckling or insufficient nutrition. It 
does not require medicine, but richer and more abundant food. In 
weakly and scrofulous children, the secretions should be examined. 
They will often be found excessively acid ; in which cases alkalies, 
especially potash, with good nourishment, will be found to remove all 
the symptoms. 

EDWARD JOHN WARING, M. D., LONDON. 

In childhood (as in old age) the same doses of medicines are not 
generally as well borne as in youth and manhood, and much nicety is 
sometimes necessary in regulating the dose. Several exceptions, how- 
ever, present themselves ; thus, in childhood (and in old age) much 
larger quantities of mercury are necessary to induce salivation than in 
manhood ; indeed, Dr. Clarke states that, in a practice of twenty 
years, he never saw a child truly salivated ; an observation corroborated 
by the experience of others. Prof. Graves ascribes the difficulty of 
inducing salivation in children and in old persons to the undeveloped 
state of the salivary glands in the former, and to their atrophied state 
in the latter. On the other hand, in infancy and childhood, opium in 
every form is a remedy that requires the utmost caution in its adminis- 
tration. Two and a half drops of laudanum have destroyed an infant 
three days old ; three drops, a strong child of fourteen months ; and 
four drops, a child of a few weeks old (Christison.) In infancy and 
childhood, blisters allowed to remain long in contact with the skin are 
apt to induce ulceration and gangrene ; and leeches, on account of the 
thinness of the skin, and the vascularity of the subjacent tissues, draw 
more blood, and consequently make a more decided impression on the 
system in an infant, than a proportionate number would produce in an 
adult. 

EDWARD ELLIS, M. D., LONDON. 

Children bear emetics well, but blood-letting badly. Blisters should 
be resorted to very seldom, as their consequences are often most in- 
jurious. More than one potent remedy should not be administered at a 
time. Remedie3 should be of moderate bulk and as palatable as pos- 
sible. Narcotics and irritants of all descriptions should be given with 
caution. Of particular remedies in children Dr. E. comments on 

Ferri Phosphas. This preparation of iron, especially in the com- 



42 



DISEASES OF CHILDREN. 



pound syrup, with the phosphates of lime, soda and potash (Parrish's 
Chemical Food), is often tolerated in infancy when other ferruginous 
preparations are not. Its pleasant taste and pretty color are to its ad- 
vantage. Dr. Ellis has given it in thousands of cases, and states that 
its value in general debility, rickets, scrofula, etc., cannot be over-esti- 
mated. 

Morphia. The very best preparation of opium we have for children 
is the bimeconate of morphia. The most suitable form is in solution. 

Hyoscyamus is of the greatest service in children's diseases, as a 
safe and efficient sedative, without the deleterious effects of the prep- 
arations of opium. For instance : 



3. R . Tinct. hyoscyami, 

Syrupi papaveros, 
Aquae menthae, 
As an anodyne for a young infant. 

4. R . Tinct. hyoscyami, 

Liquoris ammonii acetatis, 
Vini ipecacuanhas, 
Aquae ( amphorae, 
In bronchitis, etc. 



aa 



vc\y 



nLv-xv 

TT^X-XXX 
TT^X-XV 

f.5ij-iv. 



M. 



M. 



Aconite is one of the most valuable of remedies in the early stage 
of acute inflammations in children. It is anodyne and antiphlogistic. 
It should be administered in small and frequent doses to produce its 
best effect, say one-fourth or one-half a drop of the tincture of the root 
every hour. An experience of years has confirmed Dr. Ellis in his 
opinion of the value of this method in almost all acute inflammations. 
It is of less service, however, in the first three years of life than after 
this period has passed. 

Quinio? Sulphas is probably the most potent tonic for children with 
which we are acquainted. Small doses answer best for them, and it 
is often well, particularly after very exhausting diseases, to precede 
the quinia with gentian, chiretta, columbo, or some of the other minor 
tonics. (One of the most eligible forms of the cinchona alkaloids for 
children is that given in Naphey's Medical Therapeutics, 8th Ed., 
F. 891.) 



In a clinical lecture on the therapeutics of early life (Moniteur 
Therapeutique, August T, 1877,) this writer lays particular stress on 
the following points : Tincture of iodine should not be applied pure in 



SPECIAL THERAPEUTICAL METHODS. 43 

tubercular children ; it should be diluted either with glycerine or with 
some unguent. Neither iodide of potassium nor iodide of iron should 
be given to children under two years of age, except perhaps in cases of 
acute hereditary syphilis, where small doses may be administered. It 
may be given to the nurse if the child have not been weaned. Older 
children bear the drug well. Those who are especially benefited by it 
are patients robust in appearance, but with soft, inelastic flesh, and with 
manifestations of incipient scrofula. Albuminuria has been observed 
by M. Simon in a large number of cases to follow paintings of the sur- 
face with tincture of iodine, especially when applied to eruptions. 
Iodide of potassium produced the same result, but in a smaller degree. 
Piloearpin has lately been much employed in children's diseases by 
Prof. Demme, of Berne. The general conclusions drawn from his cases 
are, that piloearpin exhibits its sialogogic and diaphoretic properties in 
a very marked manner in childhood, and that it is very well borne at 
the tenderest age in the doses of gr. xV-i, its sialogogic effect being 
more prominent in the younger, and its diaphoretic effect in the older 
children ; that any unfavorable after-effects, even in the youngest chil- 
dren, are quite exceptional, and are preventable by administering minute 
doses of brandy prior to the injection; and that no influence on the 
action of the heart is perceptible. The cases best adapted for its em- 
ployment are desquamative parenchymatous nephritis with dropsy, fol- 
lowing scarlatina, diphtheria, etc. A beneficial diuresis in most of the 
cases ensues, the quantity of albumen which the urine contains never 
being increased, but rather diminished. 

SPECIAL THERAPEUTICAL METHODS. 

As it is often difficult and sometimes injurious to the child to force it 
to swallow medicines by violence, it is desirable to employ other methods 
as much as possible. 

Remedies in the form of small powders can be dropped on the back 
part of the tongue. 

Hypodermic injections are easily given and rapidly absorbed, but are 
painful. 

The delicacy of the epidermis renders inunction a most convenient 
and useful mode. Half a drachm of castor oil rubbed over the abdo- 
men will usually promptly relax the bowels of an infant. 

Dr. Dewitt C. Wade has recently laid before the profession a sug- 



44 DISEASES OF CHILDREN. 

gestive article on this subject. (Michigan Medical News, July 10th, 
1878.) He has found glyceroles the most effective forms. He applies 
them to any part of the body, first cleansing the skin of its oily secre- 
tions by sponging with the following alkaline solution : 

5. R. Liquoris ammonia?, TT^x-f. ^j. 

Aquae, f. % iv. M. 

Having carefully washed off this alkali, he immediately applies the 
glycerole. As examples he gives : 

6. R . Morphias sulphatis, gr. j-iij 

Glycerines, f.gj. M. 

For an anodyne endermic glycerole. 

7. R. Quinise bromidi, gr. xx-^j 

Glycerin*, f .§ j. M. 

For a tonic or anti-malarial glycerole. 

8. R. Extracti carnis, f.Xj 

Glycerinae, f. % iij. M. 

For a nutrient glycerole. 

It is astonishing, says Dr. W., how quickly this is absorbed and how 
promptly its effect is noticed in strengthening the pulse. Dried albu- 
men and extract of malt may also be given very successfully to the 
most feeble infants in this manner. 

Medicated baths, lotions, liniments and poultices are far more effi- 
cient in children than in adults. Very feeble infants derive much 
benefit from nutritive baths of milk, beef tea, etc., which should be of 
the temperature of the body, and in which they should remain for hours, 
if need be. The steel-bath is an excellent tonic. 

9. R. Ferri sulphatis, £ss 

Aquas (temp. 95°), gall. iv. M. 

For a bath. 

So also is the salt-bath ; four ounces of sea-salt to four gallons of 
water. For the night-sweats of children, rubbing the chest and neck 
with half a drachm of tincture of belladonna at night will be found 
most serviceable. In all other inflammatory affections of deep-seated 
organs, warm poultices and fomentations will prove to act much more 
positively than in adults. 

In children at the breast, certain medicines are successfully given by 



CLINICAL EXAMINATION. 45 

administering them to the nurse, and thus introducing them to the child 
through its food. Iron, iodine and iodide of potash can all be ex- 
hibited in this way, and in weak, rachitic infants it is by far the best 
method. Dr. Gemmel (Berliner Klinische Wochenschrift, Nov. 15, 
1877), has experimented in feeding cows with such drugs, mingled in 
their food, and giving their milk to children. The milk showed the 
characteristic reactions of iodine, etc., and had positive remedial prop- 
erties. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

These distinguished authors, in the last edition of their work on 
"Diseases of Children, '' very truly say that the clinical examination of 
children and particularly of young infants cannot be successfully 
practiced upon the same method as that habitually made use of in the 
case of adults ; the helpless silence of the infant — the wilful silence, or 
the loose and inconsistent answers of the older child, which lead astray 
the mind rather than guide it to true results — the agitation and fright 
produced by the examination, rendering it impossible at times to ascer- 
tain the real state of the different functions of the economy — and 
lastly, the difficulty of obtaining accurate and reliable accounts of the 
history of the case from the attendants, all combine to make the duty of 
the physician most perplexing, and, unless he be gifted with a large 
share of patient and philosophic calmness, most irksome and trying to 
temper. After the age of eight or ten years, the physical and intel- 
lectual development have progressed to such a point as to render the 
method of diagnosis nearly the same as that employed in adults. 

It is important that the examination should be made in two different 
conditions. 1st. While the child is calm and quiet, and 2d. While it 
is disturbed and agitated. If possible, therefore, the physician should 
always see the child when asleep, and if the mother or nurse propose, 
on the occasion of his visit, to hurry up stairs to prepare the child, or 
to bring it down in the parlor or lower room, he should ask, as a favor, 
that he may see it asleep. If, in spite of having just been nursed, the 
child be awake and fretting, we should endeavor, by the attraction of 
toys, by gentle and soothing words and manners, by fondling or by 
having it carried about the room, to get it quiet. We should be very 
particular to elicit from the parents or attendants a clear history of the 
case and all that may have transpired between our visits. We must not 
disregard what the mother may tell us, even though we do not at once 



46 DISEASES OF CHILDREN. 

see its substantiation, for we must ever remember that maternal instinct 
will sometimes discover that which has escaped the search of the most 
acute and rigorous medical observer. When we have reason to suspect 
the onset of any of the eruptive fevers, we should carefully question 
the mother as to the date of beginning of the illness ; by well directed 
questions we can determine this. It will be well to elicit all the infor- 
mation that we can from the mother or attendant before we go into the 
presence of the child, in order to avoid the risk of alarming the child, 
by the presence, during an unnecessary length of time, of a stranger. 

The most important points to be attended to during the clinical ex- 
amination, are the countenance, noting its expression, color, the pres- 
ence or absence of furrows and wrinkles from pain, from emaciation, or 
from disordered muscular action, the appearances presented by the 
nasal orifices, and especially by the alse nasi, and the characters ex- 
hibited by the mouth ; the sleep, the cry, the state of plumpness or 
emaciation; the condition of the skin as to color, temperature, moisture 
or dryness, the presence of swellings of any kind, such as those pro- 
duced by dropsy, or by affections ot the joints, and the existence of 
eruptions ; the pulse ; impulse of the heart ; the respiration ; the signs 
furnished by the state of the mouth and throat, and by the disposition 
towards and power of sucking, or by the manner in which drinks are 
taken ; and lastly, the state of the abdomen. 

In diseases of the brain, the expression of the upper part of the face, 
the forehead and the eyes, are chiefly affected, while in diseases of the 
thoracic organs, the middle portion of the face (especially the nostrils) 
are affected. Dr. M. Hall tells us that pain in the head causes a 
contracted brow, pain in the belly an elevation of the upper lip, while 
pain in the chest is chiefly denoted by sharpness of the nostrils ; but 
our authors consider that it.is impossible from the expression alone to 
tell where the pain is located. In chronic cases of all kinds where the 
nutritive functions are enfeebled, the pain assumes a pallid and waxen 
hue; in the various digestive derangements, it becomes muddy or 
sallow, and in affections of the liver more or less yellow. In pneu- 
monia, bronchitis, and pleurisy, the movements of the alae nasi become 
rapid and energetic. 

The pulse of the child, in order to be judged of to any real advan- 
tage, must be examined during the stage of quiet, and, if possible, it 
should be felt while the child is either asleep or dozing. 



ANEMIA. 47 

The physician should never think his examination of a sick child con- 
cluded until he has inquired as to the occurrence of vomiting, and as to 
the state of the discharges by stool. Not only should he inquire as to 
these symptoms, but he ought by all means to inspect personally the 
appearance of the matters ejected. This is especially important in re- 
gard to the dejections, since no description of a mother or nurse, 
however intelligent, can impart to the physician the precise and accurate 
idea of the state of those discharges, which even a very rapid inspec- 
tion would give him. 



ANEMIA. 



DR. EDWARD HENOCH, OF BERLIN. 

According to this author iron can have very little permanent benefit, 
because the most frequent cause of the affection is the constant presence 
of the anaemic children in the poisoned air of large cities, especially in 
overcrowded scliool rooms, where they are subjected to mental over- 
work. Hence the beneficial effects of the iron are constantly antago- 
nized by the bad hygienic surroundings. When circumstances permit, 
it is best to remove the children altogether from the city, and to have 
them educated in country schools, as very little is accomplished, as a 
rule, by a vacation of several weeks at the sea- shore or in the moun- 
tains. He regards a stay at the sea-shore as a doubtful experiment. 
While it has a decidedly favorable influence in a certain number of cases, 
it is entirely useless in many others, or acts unfavorably, especially if 
the timid children are forced to bathe and he therefore always prefers a 
sunny mountainous district. In a series of cases which obstinately re- 
sisted the use of iron, he found very good results from the use of Fow* 
ler's solution of arjsenic. 

DR. ARMAND SEMPLE, OF LONDON, 

Considers that the treatment depends greatly upon the state of the 
patient and upon the cause. The most important drug is iron in some 
form. The ammonio-citrate of iron is perhaps the best preparation, 
since it seldom disagrees ; it may be combined with syrup and water. 



48 DISEASES OF CHILDREN. 

The tincture of the chloride of iron, with glycerine, is especially indi- 
cated when there is a haemic murmur. Among other remedies he men- 
tions the svrup of the hypophosphite of iron, the syrup of the phosphate 
of iron, the compound syrup of the phosphates (Parrish's Chemical 
Food), the syrup of the iodide of iron and steel wine. The lozenges of 
reduced iron $re often very useful. The constipating effect of the iron 
may be counteracted by combining with it a few grains of sulphate of 
magnesia. Belladonna, in doses of 2 to 5 minims of the tincture is 
sometimes advantageously combined with the iron salts, especially when 
the heart's action is rapid. 



J. MILNER F0THERGILL, M. D., LONDON. 

The general treatment of anaemia in children, is by iron. But there 
are conditions both where a syphilitic taint exists, and where symptoms 
of it are not discoverable, where iron alone fails ; but if combined with 
minute doses of mercurials, it acts promptly and beneficially. 

DR. BOSSU, PARIS. 

10. R . Ferri redacti, 3 ss 

Pulveris canellae, 

Pulveris gentianae, 

Magnesiae, aa gr. xv. M. 

Divide into twenty powders ; one morning and evening, for children in 
cases of atony of the digestive tube. 

NOTES ON REMEDIES. 

* Calcii Phosphas is strongly recommended by Dr. Ringer, in the anaemia of 

young, rapidly-growing persons, in the dose of 1 or 2 grains, several 
times a day. 
*Ferri et Ammonii Citras is useful, especially in irritable states of the stomach, 
when it may be given with infusion of calumba. 

* Oleum Morrhuce. Dr. Ellis remarks that the secret of giving cod-liver oil suc- 

cessfully, is not to give too much, and to give it at the right time. Two 
or three drops for a young infant, \ a teaspoonful for a child of six or 
seven, is sufficient. The proper time is soon after meals and on going 
to bed. 
Phosphorus. Dr. Ellis says that perhaps the very best remedy for anaemia in 
children, is this drug. He combines it with nux vomica and iron : 

11. R . Phosphori, gr. jfo 

Ferri redacti, gr. j-ij 

Extracti nucis vomicae, gr. \. M. 

For a pill. Twice daily. 



APHTHA OF THE PALATE. 49 

Or with quinine : 

12. R . Phosphori, gr. -fa 

Quinise sulphatis, gr. j. M. 

For one pill, thrice daily, for a child of eight or ten years. 

APHTHA OF THE PALATE. 
DR. EDWARD HENOCH, OF BERLIN, 

Considers that aphthae of the palate only require treatment when they 
become larger under the influence of poor nutrition. He then applies a 
solution of sulphate of zinc (1 to 10) or nitrate of silver (1 to 15). 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

According to these authors, the discrete variety usually requires only 
topical remedies, regulation of the diet, and when there are marked 
symptoms of gastric derangement, the exhibition of some mild emetic, 
or of a laxative dose. The local treatment should consist of applications 
of demulcent preparations, as the mucilages of slippery elm, sassafras 
pith, flaxseed, marsh-mallow root, quince-seed, etc., which are to be used 
pure when there is no pain, or with the addition of a few drops of 
laudanum or wine of opium, when the mouth is sore and tender ; the 
aphthae ought to be touched occasionally with the mixture of borax and 
honey or with the following : 

13. R. Mel. rosss, f. g j 

Aluminis, g ss 

Aquse destillat., f. ^ss. M. 

The application must be made several times a day with a camel's hair 
pencil, a pencil made of charpie or cotton or with a soft rag covering the 
finger. When the ulcers which follow the vesicles, fail to cicatrize 
rapidly under the above applications, or when they are numerous and 
painful, their cure may be very much hastened and the pain quickly re- 
lieved, by touching them very lightly with a stick of nitrate of silver, or 
a piece of alum, sharpened to a point ; or we may employ a pencil 
dipped into a strong solution of nitrate of silver, or into a mixture of one 
part of muriatic acid to two of honey. Light applications daily, or on 
alternate days, with a solution of iodoform in ether, 40 to 60 grains to 
the ounce, lessen sensitiveness and promote the healing of the ulcers. 
Ether itself has been highly recommended as a local application by Dr. 
J. Worms, who has observed the fatty nature of the deposit in aphthous 
4 



50 DISEASES OF CHILDREN. 

ulcers. The general treatment of discrete aphtJice, need consist of noth- 
ing more than the use of a simple, unirritating diet in most of the cases. 
If however, the digestive apparatus is deranged, the case must be 
treated according to the symptoms ; by antacids or a gentle emetic, 
when the tongue is foul and the secretions acid ; and by the use of a 
mild laxative, as castor oil, magnesia or rhubarb, when there is constipa- 
tion. When diarrhoea is present, we should resort first to a small dose 
of castor oil or syrup of rhubarb, with the addition of half a drop to two 
drops of laudanum, according to the age of the child, and afterwards to 
astringents and opiates. 

The treatment of confluent aplithce must depend on their cause. 
The local treatment is the same as that for the discrete variety, except 
that mild cauterization should be resorted to at an earlier period. 
When they seem to depend upon a general morbid state of the consti- 
tution, as congenital debility, a scorbutic diathesis, or upon chronic 
affections of the digestive organs, they must be treated by properly 
regulated and nutritious diet, and by the exhibition of tonics and gentle 
stimulants, particularly iron, quinine, and small quantities of very fine 
old brandy. 



BRONCHITIS. 



According to this author, simple catarrh recovers spontaneously if 
the child is kept in its room, but two to three weeks almost always 
elapse before the disease has been completely cured. The use of inf. 
rad. ipecacuanha is recommended by some writers, but our author does 
not think it will shorten the attack, though it may have a sedative effect 
on the cough. When constipation and fever are present, he uses ipeca- 
cuanha in combination with calomel. 

14. R . Calomel, gr. iss 

Pulv. rad. ipecac, gr. iss 

Sacch. alb., gr. viiss. M. 

S. — Give this powder every two hours. 

But if the disease is attended with great dyspnoea and high fever, 
more energetic treatment is necessary, and in such cases he uses cups, 



BRONCHITIS. 51 

(dry or wet), four or eight, according to the age. He strongly re- 
commends hydropathic applications to the chest, from the neck to the 
umbilicus. A napkin or diaper is dipped in water at the temperature 
of the room, well wrung out and then placed around the chest, without 
exercising any compression, so that the arms are free ; this is sur- 
rounded by a roll of batting, and then covered with a layer of oil-silk. 
When the fever is high, these applications should be renewed at least 
every half hour ; later they may be kept for one or two hours, and this 
should be continued for several days and nights. These applications 
will be aided, if steam is allowed to escape from a teapot near the bed, 
thus rendering the atmosphere moist. The applications often produce 
favorable perspiration, which should not, however, be allowed to be- 
come too profuse, as it may cause symptoms of collapse. During the 
entire course of the disease it is not well to keep the child constantly 
on his back, but to change him from one side to the other, or carry him 
on the arm, in order to prevent hypostatic congestion as much as possi- 
ble. Our author coincides with the view that emetics are useful. 
When the patient is strong and healthy and can be carefully nursed, he 
uses tartar emetic. 

15. R. Antimonii et potassii tart., gr. iss 

Aq. destil, f. £ iij 

Syr. simpl, f . 3 v. M. 

Of this he gives a teaspoonful every hour until vomiting occurs, and 
then every two hours. If vomiting or perhaps diarrhoea occurs after 
each dose, the drug must be stopped at once. Even though vomiting 
is not produced after the first three doses, still he increases the inter- 
vals to two hours, in order to prevent cumulative effect. This plan is 
unsuitable for weakly children, when diarrhoea is present or in an ad- 
vanced stage of the disease. In such cases it is better to use ipecac- 
uanha. 

16. R. Pulv. rad. ipecac, gr. xv-xxx 

Aq. destill., i*. ^viiss 

Oxymel scillae, f . 3 iij . M. 

S. — One dessertspoonful every ten minutes until the effect is produced. 

In vigorous nurslings he has often found the following useful in the 
beginning of the disease : 

17. R. Vin antimonii, 

Oxymel scillae, aa f. ^iiss. M. 

S. — A teaspoonful every ten minutes until the effect is produced. 



52 DISEASES OF CHILDREN. 

As soon as numerous rales indicate the presence of profuse secretion 
in the bronchi, and the sinking powers prohibit the use of emetics, he 
recommends a strong infusion of ipecac root, decoction of senega root 
or poly gala amarse. 

18. R. Decoct, rad. senegae or polygala amarae, f. ^ iij 

Liq. ammon. anisat, f. 3 ss 

Syrup, f. 3 v. M. 

S. — Dessertspoonful every two hours. 

Mustard poultices to the sternum or back, and small flying blisters 
to the thorax, he also uses at this time. Milk, broth and wine must be 
given alternately to sustain the strength. If these articles are of no 
avail, and the loss of strength progresses, he resorts to camphor and 
benzoic acid. 

19. R. Camphorse tritae, gr. £ 

Acid, benzoic, gr. £ 

Sacch. alb., gr. iss. M. 

S. — Give this powder every two hours. 

PROF. J. LEWIS SMITH, M. D., NEW YORK. 

At the outset of acute bronchitis in children, it is often of great 
service to exhibit small and repeated doses of veratrum viride, as the 
following, for a child five years old, in the first stage of the disease : 

20. R . Tinct. veratri viridis, ^ixij 

Syrupi scillae compos., f. 3 ij 

Syrupi balsami tolutani, f. 3 xiv. M. 

One teaspoonful every two or three hours. 

When the pulse lowers, the temperature falls, and moisture appears 
upon the skin, the medicine should be omitted. The remaining treat- 
ment is by expectorant mixtures, etc. The chronic laryngitis occurring 
in children in general good health, sometimes resulting from an acute 
attack, is an obstinate affection. The patient should be warmly clad, 
and every effort made to guard against taking cold. The most satisfac- 
tory treatment is the application of tincture of iodine upon the neck, 
directly over the larynx, and in some cases, of a solution of nitrate of 
silver — 10 or 20 grains to the ounce — to the fauces, so that, if possible, 
some of it may enter the larynx. Little benefit is derived from stimu- 
lating expectorants. The following recipe has proved beneficial in a 
number of cases : 



BRONCHITIS. 53 

21. R Extracti cubebae fluidi, 1Uxl-f. 3 j 

Syrupi simplicis, i.% ijss. M. 

A teaspoonful three or four times daily. 

Chronic laryngitis, dependent on syphilis or tuberculosis, requires 
specific treatment ; local measures have but little effect. 

DR. R. FOWLER, MISSISSIPPI. 

This physician reports {Transactions of the Mississippi Stae Medi- 
cal Association, 1876), his treatment of capillary bronchitis in chil- 
dren, which is, in some respects, peculiar, and from which he has had 
the best results. 

He commences with an emetic, turpeth mineral, gr. iij, or alum, 5j- 
If there is tympanites, he avoids purgatives, but gives an enema of 
milk of assafoetida. For the fever : 

22. Be . Quinise sulphatis, gr. iij 

Potassii bromidi, gr. v. M. 

For one dose, every three or four hours, until the fever abates. 

When the temperature is above 103°, he places the child in a warm 
bath, to which cold water is rapidly added until the child's temperature 
falls to 99°. He also uses : 

23. R. Tinct. aconiti, (Fleming,) gtt. j 

Ammonii muriatis, gr. iij. M. 

This amount every two or three hours to reduce the circulation and thin 
the mucus. 

The local treatment is important. He directs a mustard cataplasm 
every six hours to the posterior portion of the thorax ; and in the in- 
tervals, have a constant relay of warm mush poultices completely en- 
veloping the chest, preceded by thoroughly anointing the surface with 
camphorated oil, before the changing of each poultice. 

For the cough, he uses chloral ; sometimes chloroform by inhalation 
— and always gr. viij iodide of iron — the latter most frequently as an 
enema, in conjunction with brandy, and chicken or beef essence, and 
in convalescence, tonics. When all these measures fail, when the 
mucus collects so rapidly in the tubes, the dyspnoea becomes more and 
more urgent, the breathing ceases, the pulse not to be felt, he has re- 
course to artificial respiration. As a dernier ressort, he would es- 
pecially recommend this measure. 



54 DISEASES OF CHILDREN. 

J. M. DA COSTA, M. D., PHILADELPHIA. 

24. R. Ammonii carbonatis, gr. xvj 

Spiritus aetheris compositi, f. 3 iss 

Syrupi tolutani, 

Aquae, aa f.§j. M. 

A teaspoonful every two hours ; a stimulating expectorant for a child a 
year old, affected with bronchitis of two weeks' standing. 

Counter-irritation to be applied to the chest by means of weak mus- 
tard plasters, (one part of mustard to four of Indian meal). Also, if 
the child be much debilitated, 15 drops of brandy every four hours. 
When the child is seen frequently, so that the effect may be watched, 
there is no better treatment than relieving the lung mechanically by 
emetics. Hoffman's anodyne, in the above recipe, acts as a diaphoretic 
and quieting agent, which latter influence would not be obtained from 
sweet spirits of nitre. 

• 

25. R. Syrupi ipecacuanhae, f.^ss. 

Liquoris potassae citratis, f. ,^ijss 

Misturae glycerrhizae compositae, f. 3 j. M. 

A teaspoonful every three hours, for a child two years of age. After- 
ward, when the disease passes into second stage, to be changed to: 

26. R. Syrupi scillae, f.gij 

Tincturae opii camphoratae, f. 5 ij. M. 

Thirty drops four times a day. 

27. R . Syrupi ipecacuanhae, f. ^ j. M. 

A teaspoonful every ten minutes until vomiting is produced ; to be re- 
peated every second day. For ordinary acute bronchitis in a child a 
year old. Together with : 

28. R. Ammonii carbonatis, gss 

Syrupi senegse, f-Kss 

Syrupi tolutani, f. % j 

Aquae, f.Sy' ss - M. 

A teaspoonful thrice daily. 

J. M. JULIAN, M. D., H0B0KEN, N. J. 

In the suffocative capillary bronchitis of children, says this writer, 
(Medical Record, October 2d, 1871,) the indications are to get rid of 
the excessive mucous secretion as speedily as possible. For twenty- 
five years he has used for this purpose, with eminent success, the fol- 
lowing : 



o 



29. R . Zinci sulphatis, gr. xij 

Tincturae sanguinariae, ^jPJ 

Aquae, i.% iss. M. 



BRONCHITIS. 55 

A teaspoonful in mild cases to a child one year old, every three hours ; in 
severe cases, triple the dose, and give it every half hour or hour, re- 
gardless of vomiting. 

PROF. J0HANN STEINER, M. D., PRAGUE. 

In chronic bronchitis and allied conditions, where there is debility 
and much irritation from the cough, this author has seen very great re- 
lief from the following prescription : 

30. R . Quinise sulphatis, gr. ij 

Pulveris folise digitalis, gr. vj 

Extracti opii, gr. j 

Pulveris sacchari albi, ad 3 j. M. 

Divide into twelve powders ; one every three or four hours. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

According to these authors, the acute simple form of bronchitis is 
frequently so mild as to need no other treatment than careful attention 
to the hygienic condition of the patient, and the administration of some 
simple febrifuge and expectorant. The child ought to be confined to 
one room, in a mild and uniform temperature, and should be kept quiet 
until the developement of the symptoms shows what is to be the type 
of the attack. Our authors believe that the practice of keeping the 
body quiet in all febrile disorders, is one of the most important thera- 
peutic means we have, and they strongly recommend that in bronchitis, 
children should be kept in bed. The clothing ought to be warm, and 
yet not sufficient to produce free perspiration, as this, by sudden ex- 
posure and evaporation, often induces chilliness. The diet must be 
simple, and may consist of any of the milk preparations, with or with- 
out bread, or bread and butter. Light soups in the middle of the day, 
or roast potatoes or apples, with bread, may generally be allowed. 
When fever sets in, our authors order : 

31. R. Potass, citrat., ^j 

Syr. ipecac, f. 3 j— ij 

Tinct. opii camph., f. 5-1 - U 

Syrup simpl. , f . 3 ss 

Aquse, q. s. ad f. ^iij. M. 

S. — Teaspoonful every two or three hours, for a child of from two to 
four years. 

This should be given until the child sleeps, and occasionally in the 
night, if there be cough and restlessness. At six months of age, the 
following may be used in the same manner: 



56 DISEASES OF CHILDREN. 

32. R. Syr. ipecac, 

Tinct. opii camph., aa f. £ss 

Spts. seth. nitrosi. vel., 

Liq. ammonii acetat., f. f ^ij 

Syr. simpl., f. %v 

Aquae, f«S\j« M. 

S. — Teaspoonful every two hours. 

If the fever is very slight, and the cough only moderately severe, it 
is often well to use no drug through the day, but, to give in the even- 
ing, two hours before bed- time and again at bed- time, some simple ex- 
pectorant and anodyne. Thus at two or three months of age, three to 
five drops of syrup of ipecacuanha with five of paregoric, or half a 
drop to a drop of laudanum ; at one or two years of age, ten drops of 
the syrup, with ten to twenty of paregoric or two of laudanum ; at five 
to ten years, ten to twenty drops of the syrup, with twenty to thirty 
of paregoric, or four or five of laudanum. The laudanum is often 
better than paregoric, as it produces a more decided and lasting impres- 
sion on the nervous system, and appears to extend its useful control 
over the symptoms further into the following day. In this very mild 
form there is no necessity for giving active purgatives. If the bowels 
are moved once in the day, or once in two days, it is best not to inter- 
fere with them. If, however, the patient be constipated, a little simple 
syrup of rhubarb, a teaspoonful of castor-oil, or an enema, will be quite 
sufficient. A warm foot-bath, in the evening, containing salt, or better, 
mustard, will often assist in moderating the cough and promoting quiet 
sleep. If, as the case progresses, the bronchial secretions become very 
abundant and the dyspnoea severe, the proper remedy is an emetic. 
This may be ipecacuanha, either in powder or syrup or a teaspoonful 
of powdered alum, to be repeated, if necessary, in ten or fifteen 
minutes. Great benefit may be obtained in all forms of bronchitis, 
from the more or less frequent application of mustard poultices to the 
front or back of the thorax, and frcm mustard foot-baths. The occur- 
rence of gastric disturbance, with coated tongue, anorexia, and a torpid 
state of the bowels, may, in some cases, call for the administration of a 
single dose of blue mass, followed by a mild saline laxative. When 
the patient is over two years of age, and the oppression very great, the 
right heart laboring, as shown by a congested surface and a throbbing 
cardiac impulse at the base and left edge of the sternum, and the 
strength not too much reduced, the abstraction of from two to four 
ounces of blood from the interscapular space by cups or leeches, would 



BRONCHITIS. 57 

be a useful legitimate practice. If the temperature is very high and 
the pulse full and strong, small doses of sulphurated antimony (gr. tV, 
in combination with Dover's powder every two or three hours), will be 
very useful in moderating the inflammatory symptoms. Should nausea 
or vomiting with exhaustion follow, they must be suspended at once. 

Counter-irritation is a very important part of the treatment. It may 
be obtained by the application of dry cups to the back of the chest, or 
if this be inconvenient, or be objected to for any cause, by the use of 
mustard poultices, which should be applied first to the dorsum of the 
chest, and after having reddened at that point, it should be shifted to 
the front of the thorax. 

In very young infants ipecacuanha is much safer than antimony, and 
it is quite active enough. When the child presents a pale surface and 
a languid expression, and particularly when the surface is very slightly 
warmer than usual, or cool, the following prescription has proved most 
useful : 

33. K. Liq. ammon. acetat, f.^ss 

Syrup ipecac, f. 3 j 

Liq. morph. sulphat., gtt. xl 

Syrup, acaciae, f. % j 

Aquae, f. J iss. M. 

S, Teaspoouful for a child two years old, to be repeated every two hours. 

If there is any nausea, the ipecac should be reduced to half the 
quantity ; and if there be any drowsiness, the morphia should be left 
out. 

It often becomes proper and necessary to make use of stimulants. 
In the suffocative form, when the symptoms become urgent, small doses 
of brandy or wine-whey may be administered alternately with the spirit 
of mindererus. In milder cases, when the symptoms indicate that col- 
lapse of certain portions of the lung has taken place, it is best to aban- 
don for the time all nauseating remedies, and to make use simply of 
brandy in doses of from five to twenty drops every half hour or hour, 
or wine-whey in dessert or tablespoonful doses and of counter-irritants, 
with very light fluid nourishment. 

In cases where there is marked debility, our authors have used, with 
advantage, small doses of quinine, as follows : 

34. K . Quiniae sulphat, gr. vj 

Acid, sulph. dil, gtt. xij 

Syr. simpl, f. J; ss 

Aquae, f. giiss. M. 



58 DISEASES OF CHILDREN. 

S. — Teaspoonful every two hours, to children two or three years old. If 
this should sicken, as it sometimes will, by the disgust its bitterness 
produces, and the consequent resistance to the doses, it is best to lay it 
aside after two or three trials and to use the following : 

35. R . Elix. cinchon. flav., f. 3 ij 

Curacoa, f . 3 ij 

Acid, sulph. dil, ^xij 

Aquae, f. ^ iiss. M. 
S. — Teaspoonful every two hours. 

In chronic bronchitis, our author recommends daily frictions with 

36. R. 01. tiglii, f.3j 

Ether sulph., f. 5 j 

Tinct. iodinii, 

Alcoholis, aa f-gfij. M. 

S. — Use locally. 



In capillary bronchitis, this physician uses 

37. R. Ipecac (pulv.), 3ij 

Sacch. alb, 3U 

Aquae fervens, f. %\v. M. 

S. — Keep hot and give teaspoonful every hour until relief is procured. 



CHRONIC BRONCHITIS. 

DR. ROBERTS BARTH0L0W, OF PHILADELPHIA. 

This author calls attention, in the Medical arid Surgical Reporter, 
1880, to the danger that may result from chronic bronchial catarrh. 
A succession of colds may produce a condition of catarrh extending 
from the nose down to the ultimate lobules in the lungs, the entire 
length of the bronchial tubes, as well as the upper air passages. In 
after life many of these children have emphysema and asthma, because 
when the ultimate bronchioles are involved, the air vesicles beyond 
them are very apt to collapse : the bronchial tubes being filled with 
viscid mucus, the residual air escapes and the sacs become permanently 
closed, while the neighboring sacs will eventually dilate. 

The first thing to be done is to clear the bronchial tubes of this 
mucus. Mechanically this may be accomplished by emetics. The sub- 
sulphate of mercury is the best, from all points of view, as it is efficient 



CHRONIC BRONCHITIS. 59 

and does not depress the patient (gr. ij-iij, in any suitable vehicle). 
What can be done to prevent the formation of this mucus ? The iodide 
of ammonium, for a child of this age, two grains every two hours, would 
be very useful. This is more efficient if arsenic be prescribed with it 
(Fowler's solution, gtt.j, four times daily). If the difficulty in breath- 
ing be not very great, we get very excellent results from the use of tur- 
pentine, which, taken into the stomach, is eliminated by the air pas- 
sages. (Of this give gtt. ij-iv every four hours). Eucalyptol is also 
very efficient. 

If the temperature rises, he gives quinine, five grains every four 
hours. Though this may seem like heroic dosing, it is necessary, 
because if this condition is not arrested, it may lead to serious changes 
in the lung structure, producing chronic catarrhal pneumonia, one of the 
varieties of pulmonary consumption. 

NOTES ON REMEDIES. 

Aconitum, in half or quarter-drop doses of the tincture in the first stage of acute 
bronchitis, is very efficient. 

Ammonii Carbonas. Dr. Stierlin, of Schaffhausen, recommends carbonate of 
ammonia rather than emetic or other treatment in the bronch-pneu- 
monia of young children and in the catarrhal attacks of infants. His 
doses range from gr. v-xx. 

Ammonii Murias. Dr. H. C. Wood (New Remedies, April, 1872,) has obtained, 
in obstinate acute bronchitis, after the first intense stage, more appar- 
ent good from the use of muriate of ammonia than any other remedy. 
The best formula is as follows : 

38. R . Ammonii muriatis, g ij 

Extract, glycyrrhizae, 3J 

Mucilag. acaciae, 
Aquae, aa f-S n J« "M- 

One teaspoonful every three hours for a child a year old. 

Ipecacuanha. Dr. Bedford Brown (American Journal of Medical Sciences, 
October, 1870,) has found the early use of an emetic of ipecacaunha 
very serviceable in a number of cases in children ; a combination of 
ipecacuanha and quinine being continued afterwards. 

Hydrargyrum. Dr. J. C. Thorowgood (Practitioner, May, 1878,) has found 
frictions with oleate of mercury to disperse threatening pulmonic dull- 
ness in bronchitis. Particularly in catarrhal bronchitis tending to 
pneumonia, with blocking up of air-cells and consolidation of lung, he 
believes we may employ mercury without fear. 

Quinice Sulphas is called for to reduce the fever in pyrexial cases, (F. 22,) 
and also as a tonic in convalescence. 



60 DISEASES OF CHILDREN. 

Tannicum Acidum. In very chronic cases attended with persistent mncous rales 
over the basis of the lungs, tannic and gallic acids are especially useful. 
(Ellis.) 

Veratrum Viride is employed in the early stages by Dr. J. Lewis Smith and 
others. (F. 20.) 






CEPHALHEMATOMA. 

DR. EDWARD HENOCH, OF BERLIN. 

According to this author the treatment should be purely effectant. 
He resorts to incision, only when the tumor threatens to suppurate and 
discharge, a termination which is exceedingly rare. It is well, under 
all circumstances, to place a soft covering (cotton) over the tumor in 
order to protect it from injury, when it will nearly always disappear, by 
absorption, in a few weeks. 

DR. M. H. BATTERSHALL, OF MASSACHUSETTS, 

Reports a case in the Medical Record, 1883, wherein compression, cold 
lotions and spirituous washes, all failed ; he then resorted to aspiration 
and drew off two ounces of very dark sanguineous fluid, then applied a 
compress, which was removed at the end of three days, revealing a 
healthy, normal condition. 



CHOLERA INFANTUM. 

DR. ARMAND SEMPLE, OF LONDON, 

Sums up the treatment by saying that it must be the same in principle 
as that of the indigestion of weaning, but the measures must be very 
prompt. Immediate efforts should be made to arrest the purging and 
vomiting. The strength should be supported and stimulants given if 
necessary. Port wine may be given with arrow-root, and brandy and 
water, or a little burnt brandy, will be found serviceable. Warm appli- 
cations, frictions, sinapisms or liniments may be necessary, and the in- 
ternal remedies should consist of catechu or kino with spirits of ammonia 
or spirits of chloroform. The ammonio-citrate of iron and chalk will be 



CHOLERA INFANTUM. 61 

found valuable ; after recovery from cliolera infantum, even though 
the bowels continue long confined, purgatives should be carefully 
avoided. 

DR. EDWARD HENOCH, OF BERLIN, 

Considers that the great danger of the disease explains the large num- 
ber of remedies that have been employed. In his opinion there is no 
specific against cholera infantum, because we are unable to destroy the 
infectious germs that have entered the stomach and intestinal canal. 
Neither quinine, carbolic auid nor salicylic acid have proved efficient, 
and hydrate of chloral only possesses a palliative effect on the vomiting. 
As it is impossible to destroy the true producers of the disease, it only 
remains to combat their effect, *. e. the fermentative processes produced 
in the stomach and intestines ; and in all cases in which the quantity of 
the infectious material introduced has not been too large, we may suc- 
ceed in securing recovery, after the complete evacuation of the toxic 
and fermenting substances. In the opposite event, treatment will be 
useless, and the children will die, despite all our efforts. He therefore 
considers that the immediate administration of opium, which serves to 
keep the offending masses in the intestinal canal, is very much out of 
place. In recent cases, i. e. in the first two or three days, he gives 
small doses of calomel. 

39. R. Calomel, gr. j 

Sacch. alb., gr. j. M. 

S. — Give this powder twice a day, and hydrochloric acid. 

40. R . Acid hydrochlor., gtt. j-xv 

Aq. destil., ±\ ^ iij 

Gum arab., gr. xv 

Syr., f.^v. M. 

S. — Teaspoonful every two hours. 

Or: 

41. B . Creasoti, gtt. ij-iv 

Aq. destil., f. ^j 

Syr., f.gss. M. 

S. — Teaspoonful every two hours. 

When signs of weakness appear, he orders twice daily a warm 
chamomile bath, in which the children remain five to ten minutes, and 
port or sherry wine, (20 drops to a teaspoonful, according to age), 
every two or three hours. Wine is often retained, when other articles 



62 



DISEASES OF CHILDREN. 



of food and medicines are immediately rejected. He advises milk 
only when cooled with ice and given by the teaspoonful. If the case 
has continued for a few days, then he commences the use of opium. 
He adds three to ten drops of laudanum, according to age, to the 
hydrochloric acid mixture, and sometimes gives a starch injection, con- 
taining one or two drops of laudanum, several times a day. The sick 
room should be as large as possible, and the bed-linen be kept care- 
fully clean. When the hydrocephaloid condition becomes more marked, 
he uses injections of camphor, 



42. & . Camphorae, 

Spirit vini., 

Aq. destil., 
S. — Inject a hypodermic syringeful. 



gr. J 



M. 



Cold champagne (a teaspoonful to a tablespoonful at a time), and he finally 
resorts to hydropathic applications and effusions of the whole body. 

M. JULES SIMON, OF PARIS. 

Where there is considerable abdominal pain, with adynamia, this 
author recommends the following : 



43. & . Bismuthi subnit, 
Vini (Malaga), 
Syr. quinquinise (fr. cod.), 
Aquae, 
Tinct. opii (at two years), 



3.ss 
gtt. lj. 



M. 



S. — A teaspoonful may be given every hour or every second hour until 
the pain disappears. 

As drinks during this period, rice water, albuminous water, and 
Sydenham's white decoction may be given. 



DR. S. K. JACKSON, OF VIRGINIA. 

This gentleman told a recent meeting of the Medical Society of the 
State of Virginia (1883), that he had never had a case of this disease 
in his practice, since he had commenced the use of the following prep- 
aration. He gives to any child that is liable to contract the disease 

44. R. Sodii sulphit., 

Sodii hyposulphit., 

Sodii bicarbonat., aa gr. xxxij 

Syr. rhei aromat., f.gii. M. 

8. — One teaspoonful or less, according to age, every two hours each morn- 
ing, until two or three doses are taken. 



n CHOLERA INFANTUM, 63 

DR. H. C. SHUTTEE, OF MISSOURI. 

This author {St. Louis Courier of Medicine, 1884), has had the 
best results with small doses of opiates, tannin, creasote and stimulants. 
Opiates, however, require caution in their use. Very small doses of 
calomel, dry on the tongue, have often a good effect on the vomiting. 
He has frequently used the compound tincture of iodine with success, 
to control the vomiting, but like everything else it often fails. He 
allows water to be used abundantly, even if it is rejected in a short 
time, for some of it will be absorbed to supply the loss in the serous 
discharges. Alcoholic stimulants are advantageous in all cases. Warm 
sponging or bathing, if the surface be hot or dry, is soothing. As col- 
lapse approaches, stimulants must be increased. As soon as vomiting 
is arrested, plenty of easily digested nourishment should be adminis- 
tered. 

DR. WILLIAM B. ATKINSON, OF PHILADELPHIA. 

According to this author {Medical and Surgical Reporter, 1880), 
cholera infantum may commence abruptly, or may be preceded by a 
diarrhoeal stage. The latter is by far the most commonly observed. 
For several days the bowels are loose, the evacuations quite thin and 
of a yellow or pea-green color, and in other cases nearly natural in 
color but of a watery appearance. This may continue for several days, 
and suddenly there occurs an explosion of the disease, heralded by 
very frequent stools, consisting almost wholly of water, often colorless 
and without odor, and along with this there ensues great irritability of 
the stomach, so that it almost instantly rejects everything that is taken. 
This irritability speedily extends to the lower intestine, so that the 
evacuations are actually squirted from the anus, often in a frothy state. 
Where the preceding diarrhoea has existed for a time, emaciation has 
gradually occurred, but when the attack is sudden, it is remarkable 
with what rapidity the child assumes the appearance of one that has 
been sick for a long time. Within a few hours it comes to look like a 
little " old man," with pinched features, sunken cheeks, hollow eyes, 
the fingers long and bony ; in short, it presents every symptom of an 
extremely rapid abstraction of the fluid constituents of the body. In 
no way can we be enabled so readily to appreciate the fact that the 
fluids are so greatly in excess of the solids in the human body, as when 
we see one of these shriveled little mortals, a living skeleton, eagerly 
demanding fluids, which are almost instantly rejected. In many 



64 DISEASES OF CHILDEEN. 

instances, the change of a few hours is so great that even those con- 
stantly in attendance upon the child fail to recognize a familiar feature. 

The progress, unless fortunately checked, is now rapidly downward ; 
the dejections soon become almost clear water, and pass away involun- 
tarily ; the child lies motionless, or with an occasional fretful fling from 
side to side; there is the most intense thirst; fluids are swallowed with 
eager haste ; there is little or no pain ; great acceleration of the pulse 
without force ; the eyes remain half closed, the lips parted ; coma sets 
in, and death soon closes the scene. 

One great peculiarity of the stools is their entire want of odor, or 
the presence of a musty smell, which is very offensive, and the presence 
of minute flocculi, so as often to give them the appearance of rice- 
water; hence the name rice-water discharges ; as a general rule, the 
urine is scanty, and often is wanting. 

In the early stages of the attack the temperature usually runs high, 
perhaps as high as in any disease of childhood, 105°-107°, but reduc- 
tion of heat rapidly ensues, commencing at the extremities, the abdo- 
men and head being the last parts to yield and become cold. 

Death usually occurs from exhaustion, and the child dies without an 
effort, though in some instances the irritation seems to extend to the 
brain and spine, and convulsions occur, or the child burrows with its 
head in the pillow, rolls the head from side to side with a monotonous, 
distressing motion, apparently unaware of what it is doing, and at in- 
tervals uttering short 3 sharp cries. Even at an early stage it is fre- 
quently the case that the child shows its irritability by a peculiar cry, 
which, once heard, is apt to impress the attentive physician as the her- 
ald of some dangerous complication. 

Epidemics of this disease differ in many ways. In some it seems to 
assume a very acute form, so that the majority of deaths occur within 
twenty -four to forty-eight hours. In others it is more chronic though 
not less fatal, and the case may be prolonged for several days or a 
week. When the special symptoms abate, the disease becomes nothing 
more than a diarrhoea, but attended with great debility. 

The differential diagnosis between this and similar diseases of chil- 
dren is made by the peculiarity of the stools — thin, watery, soon be- 
coming colorless and odorless, or musty, irritability of stomach, great 
thirst, rapid emaciation, etc. 

The correct treatment of cholera infantum is of great importance, 






CHOLERA INFANTUM. 65 

inasmuch as thus a large number of cases may be saved which appear 
at first hopeless, or which by careless or inappropriate management 
would rapidly drift down to death. 

The most prominent symptoms imperatively demanding immediate 
relief are the irritable stomach and the exhausting evacuations. To 
relieve the one and arrest the other, therefore, will be the primary indi- 
cation. For the first, the persistent vomiting, the exhibition of small 
doses of calomel, say one-twelfth to one-sixth of a grain, repeated every 
hour, will almost invariably suffice. It will be best given placed dry 
on the tongue and washed down with a sup of milk, or some bland, 
mucilaginous drink. Frequently, this so speedily relieves that the 
whole scene is changed, and often the diarrhoea is equally checked. 
No doubt, this latter symptom is, in many cases, more or less continued 
by the efforts of the child in vomiting, and that quieted, the bowels 
experience less perturbation. 

In this connection, it must be remembered that rest in the recumbent 
position is of great value, and this should be strongly impressed upon 
the attendants, who, by their mistaken though kindly meant treatment 
of the child, materially aid in keeping up a condition which is rapidly 
carrying it to the grave. When the calomel fails, the use of small 
doses of dilute sulphuric acid will often serve to put an end to the 



vomiting 



45. R. Acidi sulphurici dil., gtt. xl 

Syr. simplicis, f.gj 

Aq. menthse viridis, f.g ij. M. 

S. — One teaspoonful every half hour or hour. 

To aid our remedies we may employ some form of warm fomentation 
to the stomach. Or, by producing a positive redness of the surface of 
the epigastrium, by means of a mustard plaster, great relief is frequently 
obtained. Other and very useful methods are poultices of hops, spice 
plasters, and the application of a few leeches to the surface of the epi- 
gastrium. 

Additional medicaments are chloroform, in drop doses frequently re- 
peated, mixed with mucilage of acacia and a little syrup, followed im- 
mediately by the application of a small piece of ice in a cloth, so that 
it may slowly be dissolved ; small doses of camphor dissolved in ether ; 
or powders of the subnitrate or subcarbonate of bismuth. 

To arrest the frequency of the discharges, a very useful remedy is 



66 DISEASES OF CHILDREN. 

the subnitrate of bismuth, in five to ten grain doses, with the compound 
powder of ipecacuanha : 

46. R. Pulv. ipecac, comp., gr. iv-vj 

Bismuthi subnitrat., 3J. ^- 

Ft. in chartulse, No. xij. 
S. — One every two to four hours, according to circumstances. 

Where the exhaustion is great the bismuth may with much advantage 
be combined with the aromatic spirits of ammonia, which is a most 
excellent stimulant in all cases of exhaustion in children ; or it may be 
given separately while the bismuth is continued, with or without the 
ipecac powder. In employing any narcotic, particularly opium, great 
watchfulness must be observed as to its results. It is always contra- 
indicated where the disease is complicated with brain symptoms. Give 
it in small doses, with care, and withdraw it as soon as the evacuations 
are checked, or if necessary, continue it in greatly reduced doses. For 
children, the camphorated tincture of opium is preferable to the tinc- 
ture. 

The diet must be mainly milk, with lime water, beef tea, mucilagi- 
nous fluids. Brandy or whisky should be added from the outset, and 
continued in small but frequently repeated doses, until recovery has 
proceeded so far as to render stimulation unnecessary. To relieve the 
intense thirst, ice in small pieces may be rubbed over the gums and 
allowed to dissolve in the mouth, or a teaspoonful of cold water, at 
short intervals, may be given. The child should never be allowed to 
suffer for want of it. 

Frequent sponging with alcohol and water, or tepid water alone, will 
prove advantageous. This is better than the use of the bath, as the 
necessary movement of the patient is liable to add greatly to the ex- 
haustion, or to induce it. In addition to these measures, there must 
be the most scrupulous attention to ventilation and cleanliness. Never 
allow the child to remain in an overcrowded room ; better that it should 
sleep in the open air night and day. 

Perhaps a most fruitful cause of bowel affections in children, and also 
in adults, is exposure to a draught at night, or rather toward morning, 
when the temperature is usually at its lowest. In their restless toss- 
ing, by reason of the heat, they become completely uncovered, and so 
lie exposed ; the legs and abdomen are chilled, producing congestion 
of the bowels, and a diarrhoea! attack ensues. 



CHOLERA INFANTUM. 67 

Regarding cholera infantum as usually, if not invariably, the result 
of congested bowels, good effects have been observed after the employ- 
ment of a positive counter-irritant to the surface of the abdomen, and 
also to the whole length of the spine. The best rubefacient is a lini- 
ment composed of ammonia, turpentine and castor-oil : 

47. R. Liq. ammoniae, f-2>ij 

01. terebinthinse, f -Q*J 

01. ricini, f. 3 iv. M. 

Ft. linimentum. 

Rub the abdominal surface and the spine briskly with this, so as to 
redden the skin, and repeat about every two hours. In many in- 
stances immediate good results follow, and the patient rapidly con- 
valesces. 

As the case progresses tonics may be given, to aid the recovery of 
strength. 

Quinine is especially the children's tonic, is readily tolerated, and 
rarely fails to prove of value. As a tonic for weak bowels, the solution 
of nitrate of iron cannot be excelled. It is best combined with a vege- 
table bitter. 

In those cases where the progress is less favorable, where the brain 
becomes involved, it will be necessary to employ cool or cold applications 
to the scalp, and this may be best done by the use of the ice cap, ice 
in a rubber bag or bladder, or pieces of ice in a folded towel. At the 
same time, hot pediluvia, sinapisms or rubefacients to the lower extrem- 
ities, will aid in inviting the blood from the brain. It must not, how- 
ever, be forgotten, that cerebral symptoms may be simulated by 
exhaustion, for which the proper treatment will be more positive stimu- 
lation and larger doses of quinine and iron in some form. Blisters in 
very young children are always a remedy of doubtful value. Often 
they do not seem to produce sufficient advantage to compensate for the 
annoyance they give the little sufferer. A blister should never be 
placed upon the nape of the neck, as we thus inflict upon a child a 
terrible punishment, compelling it to lie almost wholly upon its face, in 
order to escape the irritation caused by the rubbing and pressure of the 
blistered surface upon the heated pillow. When deemed absolutely 
necessary, they may be applied behind the ears, and most easily by 
means of the blistering collodion. 

Where there exists positive evidence of cerebral congestion, a better 



68 DISEASES OF CHILDREN. 

plan will be the application of two or three leeches to the temples, 
being careful not to allow the bleeding to continue too long, and thus 
complicate the case further. After this the cold applications may be 
continued as indications present. 

For great restlessness, and to insure a good sleep, bromide of potas- 
sium or sodium, and chloral may he given without hesitation, and with 
the expectation of good results. 

Finally, never despair of a happy issue, as we constantly see cases, 
apparently desperate, recover, as if to confound our evil prognostica- 
tions. Persevere judiciously, but earnestly, until death itself prevents 
further efforts. 

With convalescence, it must constantly be borne in mind that re- 
lapse is extremely liable to occur. Therefore, eternal viligance will be 
necessary in the diet, ventilation, clothing and exposure. 

DR. ELLWOOD HARVEY, OF PENNSYLVANIA. 

This author in a paper read before the Medical Society of the State 
of Pennsylvania, 1879, calls attention to the efficacy of blisters upon 
the head in controlling cholera infantum. In mild cases they may not 
be needed, but in every case the patient is sooner well when they are 
used. In severe attacks they seem to be indispensable. They should 
be put upon the denuded scalp, not upon the bare skin, and should be 
left on until they have done all that they can do. If taken off too soon, 
they do very little good, though the cuticle may be raised. The hair 
must be cut off close to the scalp, and suitable places are the sides of 
the head above the ears. If the cerate of cantharides is spread thick, 
about as large as a silver dollar, or larger, on surgeon's adhesive plaster, 
with a margin of plaster to secure adhesion to the scalp, and the adhe- 
sive border clipped with scissors toward the centre so as to secure a 
smooth application, and if the plasters are then kept on for eight or 
ten hours, there will not be a failure. The serum that discharges upon 
the neck and ears, should be carefully washed off, or it will cause blisters 
on the bare skin, where they are annoying. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

After noting the prophylactic treatment, our authors divide the treat- 
ment of the attack into three stages, those of evacuation, collapse and 
reaction. If it be found that the child has certainly eaten some un- 
wholesome article of food, and that it has not come away in the dis- 



CHOLERA INFANTUM. 69 

charges, then it is right to give at first a moderate purgative, such as 
castor oil or syrup of rhubarb, with a small dose of laudanum, or two 
drops of chiorodyne, for a child two or three years of age. If two 
hours after the use of these drugs the stools still continue frequent and 
watery, they resort to the chalk mixture, with tincture of krameria and 
laudanum or paregoric. In the stage of collapse, supportive treatment 
is called for. Ten or fifteen drops of old and delicate brandy in a tea- 
spoonful or tablespoonful of ice-water, ought to be given every hour or 
two hours, at one year of age. Our authors allow ice and cold water, 
almost without limit, to children in thte condition, and they consider it a 
most important and much neglected item of the treatment. During the 
stage of collapse, the only available food is thin chicken tea, Liebigs' 
cold extract of beef or weak wine-whey, given in small doses frequently 
repeated. It is worse than useless to attempt more than this, as not 
only is it not retained, but it evidently tends to keep up the nausea and 
vomiting, and thus retard the natural effort at reaction. It is best to 
keep the child in bed, but if it clings to its mother's or nurse's lap, its 
inclination should be gratified. When the tendency to cooling of the 
body shows itself, and this is usually first noticeable in the hands and 
feet, ears and nose, he should be kept trapped in warm, dry and soft 
flannels or blankets. Flannels heated at the fire, thus supplying dry 
artificial heat, are of great use here. Bottles or tins filled with hot 
water, ought to be placed at the feet, under the blanket. A warm, soft, 
and light poultice of Indian meal or flaxseed, with a little mustard in- 
corporated with it, may be placed over the abdomen, or three or four 
thicknesses of flannel, wrung out of hot water and whisky, may be laid 
over the lowest part of the thorax and abdomen, and covered with oiled 
silk, to retain their heat and prevent the wetting of the clothes. 

When the case takes a favorable turn and the reaction stage begins, 
it is usually best to do nothing more than supply food and water care- 
fully, and keep the body trpnquil and quiet. A very good food is that 
made of equal parts of milk, cream, lime water and plain water. If 
the case progresses well, drugs are not needed ; if however, the fever 
runs high, we may use small doses of the spirits of nitrous ether. If, 
as often happens, the urinary secretion remains scanty, water, in such 
quantities as the stomach takes willingly, makes the best diuretic. In 
the early stage of cholera infantum, before collapse has begun, and 
whilst the child is still reasonably strong, and particularly when there is 
marked febrile heat and dryness of the body, the use of the warm or 



70 DISEASES OF CHILDREN. 

hot bath, or of sponging with hot water and spirit, are excellent meas- 
ures. The bath may be used twice or even three times a day, if the 
child does not resist and scream. The temperature should be 95° to 
98°, and the child may be kept in the water from five to ten minutes. 
It is an excellent plan to wrap the child, directly upon lifting it from 
the bath, in a heated muslin sheet, and to apply over this a blanket and 
keep it, thus enveloped, on the lap, for half an hour or more, if it is 
comfortable and disposed to rest. If the child be somewhat weak, 
whiskey added to the water, makes the bath more useful and safe. 

J. LEWIS SMITH, M. D., 

Professor in Belle vue Hospital Medical College, New York. Prompt 
measures are required in cholera infantum, as the child rapidly sinks 
under the prostrating influence of the frequent watery discharges. 
Some evacuant is indicated at the outset, if there be any irritating 
material in the stomach or bowels, causing or keeping up the trouble. 
Small doses of ipecacuanha (from two to five grains) are often bene- 
ficial. When, however, the stomach is irritable and the alvine dis- 
charges fail to carry off the intestinal contents, calomel is the great 
remedy. As it is slow in its operation, castor oil may be administered 
after it with benefit, or its operation may be aided by a simple enema. 
It should not be given to the extent of more than one or two doses. 

If there be no indigestible substance in the intestines, purgatives are 
contra-indicated, as they are then hurtful. The continuance of the 
diarrhoea for several hours affords a pretty sure evidence of the removal 
of any irritating matter which may have been present, and hence no 
purgative is required. The objects of the treatment then should be to 
diminish the frequency of the evacuations, and improve their character. 
No time should be lost. Opium in some form is the chief reliance. 

If laudanum be used, it may be administered in one-drop doses, 
every two or three honrs, to a child one year old. Its effect should be 
watched. If the evacuations are partially checked, and there are signs 
of stupor, stop the opiate, or at least give it less frequently. 

Astringents, and often alkalies, may be employed as adjuvants to the 
opium. The opiates and alkali may be employed in the following com- 
bination : 

48. R. Tiucturse opii, gtt. xij 

Mistune cretse, f.giss. M. 

One teaspoonful every two or three hours to an infant one year old. 



CHOLERA INFANTUM. 71 

To this mixture an astringent may be added, as tincture of catechu 
or kino. It should be borne in mind, however, that astringents are 
less tolerated by an irritable stomach than opium or chalk. When 
they are vomited, therefore, they should be discontinued, even in cases 
in which they would doubtless be serviceable if the stomach were 
retentive. 

By means of the opiate and astringents, if they be retained, the 
passages are rendered, in a few hours, less frequent, and the stools 
more consistent. 

In cases in which calomel is employed our author does not recom- 
mend its use in larger doses than one-fourth of a grain morning and 
evening (together with the astringent and opiate), to a child of one year. 

Dr. S. also advises small pieces of ice in the mouth at the beginning 
of the attack, to combat the irritability of the stomach, and the appli- 
cation of mustard to the epigastrium. 

In most cases, Bourbon whiskey or brandy, the best of the alcoholic 
stimulants, are required. They should be used from an early period 
of the disease, both for the purpose of sustaining the vital powers and 
of diminishing the gastric irritability. 

The diet should be simple, but nutritious, and taken often, but little 
at a time. If the child be at the breast, it should be confined to the 
mother's milk. If it be weaned, cold barley or rice-water, with whisky 
or brandy, should be given in the commencement of the attack ; after- 
ward, milk or broth may be employed in addition. 

49. R. Creasoti, gtt. j 

Aquae calcis, f. ^ij. M. 

One teaspoonful with a tea-spoonful of milk, breast milk if the infant 

nurses, repeated as required, for the vomiting so frequent in the summer 

epidemics of intestinal inflammation, in the cities. 

This recipe is much used in the Nursery and Child's Hospital of 
New York city. Or, the following may be administered: 



M. 



This author gives the following indications for the treatment of 
cholera infantum : 



50. J& . Potassii bicarbonatis, 






gr. xxv 


Acidi citrici, 






gr. xvij 


Aquae amygdalae amarae, 






f-3J 


Aquae, 






f.^ij- 


Teaspoonful, repeated as required. 








MEREDITH CLYMER, M. 


D., NEW 


YORK 





72 DISEASES OF CHILDREN. 

The instantly threatening symptoms, purging and vomiting, are to be 
stopped. Fermentation and not chymification, is going on in the 
stomach and duodenum. Hence, small doses of the bisulphites of 
sodium and potassium, with limed whey, will often act very happily, 
while the effect of poisonous drugs is always doubtful, and generally, 
positively harmful. Mercury is, at best, negative. Opium and its 
preparations will be found valuable, if not contra-indicated by cerebral 
epiphenomena. The effects should be carefully watched. Flannel, 
wrung out of hot water, and on which laudanum is poured, applied to 
the spine, will be found useful in checking vomiting. The function of 
the skin, which, in common with all the excreting organs, is inactive, 
must be excited. This may be done by gentle friction with woolen 
cloths, or a warm alkaline bath, in which the little patient should not 
remain longer than three minutes, being then quickly dried and wrapped 
in flannel. Food, of proper quality and quantity, should be given as 
soon as the stomach and bowels will tolerate it. Farinaceous articles 
are entirely inappropriate. Limed milk, to which a little gelatine has 
been added, or rennet whey, may be given ; but in protracted cases, 
attended with great prostration and rapid emaciation, the raw meat 
diet, prepared as recommended by Prof. Trousseau, will be often 
seized with avidity and well borne. Lean beef or mutton is first finely 
hashed, pounded in a mortar to a pulp, and then passed through a fine 
sieve. The thick concentrated juice thus obtained is nutritious and 
digestible, and, when salted or otherwise flavored, quite acceptable. 
Give a half to three-quarters of an ounce, in fractional doses, the first 
day. If well borne by the stomach, increase the quantity day by day, 
until a quarter or half a pound is taken in the course of the twenty- 
four hours. For the first day or two, much of it may pass, hardly 
changed, from the bowels; but this alone should not occasion its dis- 
continuance. If too long continued, however, this diet is liable to gen- 
erate taenia. White of eggs, thinned with natural or artificial Seltzer, 
Vichy, or weak lime water, is an excellent drink, to which a few grains 
of bicarbonate of soda may be added. Tonics and stimulants are often 
required. Of the former, minute doses of arsenic, alone or combined 
with quinine, or the chloride of iron, or the pernitrate of iron, or the 
tincture of nux vomica, may be given. Wine whey, or brandy and 
water, to which a few drops of the aromatic spirits of ammonia have 
been added, are the best stimulants. The effect of sending the patient 
to a cool and mountainous region is immediate and lasting. 



CHOLERA INFANTUM. 73 

M. D., PHILADELPHIA. 

This practitioner has employed the following treatment in cases of 
cholera infantum, with the best results : 

■ 

51. R . Hydrargyri cbloridi mitis, gr. ii 

Bismuthi subcarbonatis, gr. xvj-xl 

Pulveris ipecacuanbse compositae, gr. j-ij 

Pulveris sacchari albi, gr. xij. M. 

For eight powders ; one to be taken every tbree bours, for two or tbree 
days, or until the tongue and mouth become moist, and the alvine excre- 
tion changed in color and consistency. 

Then the following powders are given, and will ordinarily complete 
the cure : 

52, R • Bismuthi subcarbonatis, gr. xvj-xl 

Pulveris ipecacuanhae compositae, gr. j-ij 

Pulveris aromatici, gr. viij-xvj 

Pulveris sacchari albi, gr. xij. M. 

For eight powders ; one to be taken every three or four hours, in the 
mother's or cow's milk. 

Counter-irritation is kept up over the abdomen with mustard plasters, 
applied at intervals of three or four hours. The infant is allowed to 
suck at a piece of ice held in its mouth. When stimulants are required, 
the doctor gives from 15 to 30 drops of port wine. When the infant 
is artificially fed, he gives it cow's milk and lime-water, in the propor- 
tion of 1 fluid ounce of the latter to 5 fluid ounces of the former ; also, 
broiled mutton or beef, minced very fine. All farinaceous food is for- 
bidden. The child must be nursed or fed at regular intervals, and not 
allowed too much at a time. 



In threatening cases, this physician recommends 

53. R . Acidi carbolici crystallisati, gr. iij 

Glycerinae, f. 5 ss 

Tincturae opii camphoratae, f. % j 

Aquae, fjiss. M. 
Give 20 drops every half hour, till the vomiting ceases, then every four 
hours. 

54. R . Hydrargyri cbloridi mitis, gr. iv 

Pulveris opii, gr. j 

Sacchari albi, gr. xx. M. 
Make eight powders. Give one every eight hours. 

If the vomiting ceases, but the discharge continues, and the child is 
fretful and emaciates, then : 



74 DISEASES OF CHILDREN. 



55. R . Olei terebinthinae, 






f-3ij 


Olei gaultherise, 






gtt. XX 


Tincturse opii, 






f-3ij 


Pulveris acacise, 








Sacchari albi, 




aa 


3iv 


Aquae, 






f.^"j. 


From 15 to 30 drops every three 


or four hours. 







M. 

DR. BEDFORD BROWN, VIRGINIA. 

The great danger in cholera infantum, according to this writer 
(Medical Times, September, 1877), is the supervention of thrombosis 
or embolism. When this is once established, the case is almost hope- 
less. But much may be done to prevent it. 

In the first place, it is necessary, as far as possible, to avoid the 
paralyzing influence of a high degree of temperature on the system. 
A change of 20° will almost invariably accomplish that result. If this 
be not practicable, then one of our best correctives is the use of the 
cold bath, systematically, night and morning, followed by ample and 
efficient friction previous to and during the attack. Whenever re-action 
follows, good is certain to result. Secondly, vomiting and purging 
must be arrested, for the purpose of preventing undue waste from the 
blood-vessels. For the latter, the remedies are enemata of water, fre- 
quently repeated, containing, in minute solution, alum or tannin, glycer- 
ine, and an appropriate portion of tincture of opium. In these cases, 
water is better than starchy matter, as a vehicle, as it aids in supplying 
the wasted serum. To arrest vomiting, bismuth, combined with minute 
quantities of cerium and alum, and the free use of ice and iced gum- 
water, are advisable. They must be given in small doses, repeated 
every half hour or hour. 

In regard to food and drink, iced gum- water may be used ad libitum, 
in bad cases. Nutriment must also be given in a perfect state of solu- 
tion, ready for rapid and easy absorption. 

The form of the particular nutriment to be adopted in cholera in- 
fantum, is a question of vital moment, and one on which depends the 
final result. 

During an attack, food containing fibrinous or caseous matter, cannot 
be digested. Albumen in extreme dilution, as that of eggs beat up and 
highly diluted with sweetened water ; the water in which good bread or 
crackers have been boiled ; mutton or lamb broth, very delicately made ; 
beef tea made only by extracting the juice of the fresh lean meat with 
cold water, and then properly cooked, constitute forms of nutriment 
which can be absorbed and carried into the circulation without difficulty. 



CHOLERA INFANTUM. 7D 

NOTES ON REMEDIES. 

Argenti Nitras is recommended after the subsidence of the acute symptoms. 

Belladonna. Dr. Uhler, of Baltimore, has succeded in severe cases with this 
drug after opiates and other remedies had been tried in vain. 

Bismuthi Subnitras is valuable to control the evacuations in the later stages of 
the disease ; and as a preventive of vomiting and nausea in its earlier 
stages. 

Cantharidis Tinctura, in doses of gtt. x at intervals of ten or fifteen minutes to a 
child of eighteen months has been used successfully to combat the stage 
of collapse, by Dr. C. L. Gregory, of Ohio. {Cincinnati Lancet and 
Observer, July, 187C.) 

Carbolicum Acidum has been tried with varying results. It cannot be said to 
have established a reputation in this disease. 

Cerii Oxalas is recommended by a writer in the Concours Medicate 1880 ; he 
divides four grains into ten powders, one to be given every hour to a 
child under two years of age. 

Creasotum is often efficient in relieving the nausea and vomiting. 

Cupri Sulph. is a good remedy, but only the smallest doses are admissible. 

Hydrargyri Chloridum Mite has been very extensively used. In addition to au- 
thorities already given we may quote Dr. Henry Harts horne, of 
Philadelphia, who advocates it, in moderate doses in the early stages, in 
strong language. He always gives it with an antacid, as : 

56. R . Hydrargyri chloridi mitis, gr. ij 

Sodii bicarbonatis, h)j 

Pulveris zingiberis, gr. xij. M. 

Make twelve powders. One three or four times daily. 

When the diarrhoea is more prominent, he gives the above ; when the 
stomach or head is more involved, he replaces the bicarbonate of soda 
by magnesia. 

Hydrargyrum cum creta. This is preferred by many practitioners to calomel. 

Ipecacuanha is a desirable remedy when the stools assume a dysenteric char- 
acter. 

Lactopeptine administered at a sufficiently early stage modifies the secretions 
promptly and favorably, and leaves no after effects of an unpleasant 
character. 

Opium in some form may be given, but with great caution. 

Potassii Bromidum has been pronounced by some a specific, by others worthless. 
It is certainly inefficient in many cases ; it is especially indicated in 
cases characterized by nervous irritability and feverishness. 

Qumim Sulphas, or some similar cinchona alkaloid, is indispensable in cases of 
a malarial aspect. 

Rheum is a very valuable adjuvant. Spiced syrup of rhubarb is a popular 
form. Dr. W. M. Gross, of Illinois, pronounces calcined and pulver- 
ized rhubarb the " very best" remedy for the disease. (Ohio Medical 



76 DISEASES OF CHILDREN. 

Recorder, January, 1878.) He gives gr. v. to a child six months, re- 
peating as necessary, without other medication. 
Zinci Oxidum is, in the opinion of Dr. V. S. McNider, superior to astringents 
after the acute stage of the disease is past. {Medical and Surgical Re- 
porter, August, 1876.) 

EXTERNAL MEASURES. 

Baths are of the highest importance. In the algid stage Steiner strongly urges 
baths of 99° to 104° Fah. combined with stimulants internally. Mus- 
tard baths of not less than this temperature may be used. As more 
convenient, Dr. E. W. Emerson, of Boston, recommends wrapping the 
children to the chin in cloths wrung out with hot water and mustard 
with a blanket outside, and while thus enveloped feeding them with ice 
water and a little brandy. {Boston Medical and Surgical Journal, July 
27th, 1876.) In early stages, when the temperature is high and thirst 
great, cool sponging or even the cool bath, is approved by some. 

Emplastra. For the relief of the vomiting a spice poultice or plaster on the 
epigastrium is often of service. 



CHOREA 



DR. EDWARD HENOCH, OF BERLIN. 

Arsenic holds the first place in the estimation of this distinguished 
authority, but even this drug does not show any constant effects. He 
orders : 

57. R. Solut. arsen. Fowl., n^xxx 

Aquae destil., f. 3ij- M - 

S. — Ten to fifteen drops three times a day, one hour after meals. 

Given in this way, it rarely produces nausea or diarrhoea. If the 
stomach will not tolerate the remedy, he would give it by hypodermic 
injection. In very severe cases the addition of a small quantity of opium 
seems to increase the efficacy of the above formula. If violent move- 
ments continue at night on account of insomnia, he gives chloral hydrate. 
But chloral is only useful in beginning treatment and must give way to 
arsenic, after quiet and sleep have been secured. If the patients are 
not anaemic, purgatives have proved beneficial. He gives purgatives in 
the beginning for a couple of days, and afterwards discontinues the 
arsenic once a week, for twenty four hours, giving castor oil or compound 
infusion of senna instead. Mental exertion should be avoided as much 
as possible during the continuance of the chorea, and attendance at 



CHOREA. 7 7 

school should therefore be prohibited- In very severe cases the chil- 
dren must be held in bed, surrounded by pillows, to prevent contusions. 
Nourishing diet, pure air, cold water friction in the morning, if not dis- 
tasteful to the children (lukewarm baths, in the other event), and finally 
preparations of iron, are to be strongly recommended as after treatment. 

58. R . Ferri lactici vel reducti, gr. ss-j 

Sacch. alb, gr. j. M. 

Give in one powder two or three times a day. 

DRS. MEIGS AND PEPPER, OP PHILADELPHIA. 

According to these distinguished authorities on " diseases of chil- 
dren," the only rules to be laid down for the treatment of chorea are 
those which apply to all the convulsive affections depending on functional 
disorder of the nervous system, and on disordered states of the general 
health, connected with a faulty condition of the functions of digestion 
and assimilation. These are attention to the general health, and espe- 
cially a careful regulation of the diet and other hygienic conditions of 
the patient, the removal of any local derangement or disease that may 
exert an unhealthy influence upon the nervous system, the use of tonics 
and iron, and the employment of such remedies as have been found to 
exert a controlling influence upon spasmodic and convulsive affections 
generally and upon this disease in particular. 

When the discharges from the bowels are clay-colored, or dark and 
offensive, when the mouth is pasty, the tongue loaded with a thick 
yellowish fur, and the breath heavy, it is proper to employ a mercurial, 
Of antispasmodics, our authors prefer the root of the cimicifuga or 
black snake-root, valerian, assafcetida, oxide of zinc, camphor, bromide 
of potassium, conium and calabar bean. 

The cimicifuga is given in powder, tincture, decoction, or fluid extract, 
and should be continued for several weeks, in gradually increasing doses, 
until some visible effect is produced, as nausea, headache, vertigo, or 
disordered vision. Our authors prefer the decoction, of which they 
give to children of eight or nine years old, from four ounces to half a 
pint a day, made in the proportion of half an ounce of the root to a pint 
of boiling water. The bromide of potassium has proved serviceable in 
cases of rheumatic origin, in combination with iodide of potassium and 
iodide of iron. Of the preparations of valerian, they prefer the fluid 
extract, of which half a teaspoonful may be given to a child eight or ten 
years old, three times a day, and the quantity gradually increased. 



78 DISEASES OF CHILDREN. 

Arsenic has been used with excellent results in a large proportion of 
cases. They administer it in the form of Fowler's solution, given in 
ordinary doses, immediately after eating, and persisted in until some 
of its constitutional effects are produced. We should carefully watch 
for these, and immediately reduce the dose until the signs of irritation 
have passed away, and then cautiously increase it. The bitter wine of 
iron may be advantageously combined with the arsenic. In some cases, 
the hypodermic use of arsenic, in large doses, will prove serviceable. 

When the symptoms indicate the approach of nervous exhaustion, 
alcoholic stimuli are to be used. Whenever the disease occurs in 
anaemic and debilitated individuals, ferruginous tonics are called for. 
The best of which are the subcarbonate, Vallet's pills, the syrup of the 
iodide, and the pure metallic iron (ferrum per hydrogen). Quinine 
may be combined with the iron. When there is any reason to suspect 
a tubercular predisposition, cod-liver oil should be ordered. 

Cold plunge, and shower baths, as well as cold effusions to the nape 
of the neck and along the spine, may be used if there is full reaction 
and the child is willing to submit to them. 

In violent cases, the patient must be confined to bed, and it may be 
necessary to have padded sides made for it to prevent him from dashing 
himself out of bed in his uncontrollable and violent movements. 

CONVULSIONS. 
DR. EDWARD HENOCH, OF BERLIN. 

When he finds a child in convulsions, this author considers that there 
is no time to enter minutely into the cause of the attack, but you must 
commence treatment at once. If an attack lasts more than five minutes 
he does not dally with other drugs, but resorts at once to chloroform. 
A drachm of chloroform poured on a handkerchief and held in front of 
the child's nose, so that a stratum of air supervenes, often proves suf- 
ficient. When the convulsions are due to overloading of the stomach 
or intestines, the treatment indicated is, of course, purgatives and 
emetics, ol. ricini ; inf. sennge comp., etc. When the abdomen is 
markedly distended, it is advisable to give an enema, even during the 
spasm, of milk and honey (2 to 1) or of cool water, in order to empty 
the bowels. When worms are known to have been present or when 
there is good reason to suspect their presence, anthelmintics may be 
given. 



CONVULSIONS. 79 



According to this author, recovery is the usual termination ; but 
when death occurs it is usually from asphyxia, shock or syncope ; in 
cases where the convulsions rapidly recur, the prognosis is very grave. 
As the frequency of recurrence diminishes, so does the danger to life 
lessen ; but there is a risk of their becoming habitual. He thinks that 
there appears to be a marked relation between the convulsions of early 
infancy and the development of epilepsy in subsequent childhood. He 
considers that the chief point in the treatment is to ascertain the cause. 
The child should be placed at once in a warm bath, cold water being 
simultaneously poured over the head and face. For great distortion of 
the body during the fit, he uses chloroform ; though there is no neces- 
sity to produce deep anaesthesia. If dentition is the cause, and the 
gums are tense, they should be freely lanced. If irritation of the bowels 
is present, they should be cleared by appropriate remedies. Worms 
should always be suspected, and remedies suitable for their removal 
should be given. If the child cannot swallow, an enema may be given 
in the intervals of the convulsions ; to ward off the attacks, he regards 
the bromides of potassium and ammonium as useful. If there is sleep- 
lessness, a few grains of hydrate of chloral often do good. When the 
convulsions have ceased, the proper remedies are cod liver oil and iron 
preparations, such as vinum ferri and syrupus ferri hypophosphitis. 

DR. C. POLLOCK, OF INDIANA. 

This author relates, in the Medical and Surgical Reporter, 1883, 
the case of a healthy baby aged five months, in whom very severe con- 
vulsions were caused by a narrow prepuce which enclosed a large 
amount of smegma, which had irritated the glans penis and caused the 
convulsions by reflex action. This is a cause that is often overlooked 
by both physicians and parents, and yet it is a not infrequent cause of 
infantile convulsions that are overlooked or attributed to some other 
cause. Dr. Pollock slit up the prepuce and removed the smegma, and 
as soon as the cut surfaces healed, the convulsions ceased. 

DR. CHARLES BELL, OF SCOTLAND. 

This author describes in the Edinburgh Medical Journal, 1880, 
what he calls " Inward Fits of Children." The disease is common 
in infants within a few months after birth. The child lies as if asleep, 
but the eyelids are partially open, aud have a twinkling motion, the 



80 DISEASES OF CHILDREN. 

eyes are turned up so as to show the white, the muscles of the face and 
lips have a tremulous motion, producing an effect as though the child 
were smiling. As the disease increases the breathing is occasionally 
interrupted, the features become pinched and a livid circle forms 
around the eyes and mouth. There is restlessness and starting during 
sleep, and the child is disturbed by the slightest noise, and sighs and 
brings up wind, after which it lapses into a drowsy state. In simple 
and mild cases the disease disappears as the child's strength improves, 
but if it is improperly treated the drowsy state increases, and a sort of 
thrush appears, accompanied by feverishness, sour vomiting, watery 
stools, gripes, which may terminate in regular convulsions. It is clear 
that the symptoms just described are the result of something irritating 
the bowels, hence a dose of magnesia will usually be sufficient to re- 
move it. Should this not suffice, it may be necessary to attend to the 
state of health of the nurse, and to give the child the benefit of change 
of air. 

This same author tells us (Edinburgh Medical Journal, 1879,) that 
the first object in the treatment of convulsions is to allay the spasm and 
to restore consciousness. This is generally effected by means of a hot 
bath, and at the same time applying some pungent substance to the 
nose, such as ammonia, bhould these not be effectual in restoring 
sensibility and overcoming the convulsions, we must have recourse to 
the application of chloroform. Having overcome the convulsions, we 
should then endeavor to remove the cause, which is most commonly 
something irritating the alimentary canal. If the child has recently 
taken a full meal, an emetic ought to be given as soon as the patient is 
able to swallow, and the best kind under the circumstances is a full dose 
of ipecacuanha, according to the age of the child. If the bowels are 
constipated, an aperient should be given, either of calomel or castor oil ; 
but as it is important that the bowels should be moved quickly, an 
enema or a suppository should be administered without delay. Cold 
should be frequently applied to the head if there is much heat, while 
the feet are kept in warm water, or mustard poultices should be applied 
to the calves of the legs. If there is much excitement in the circula- 
tion, leeches may be applied with advantage, although M. North prefers 
venesection or cupping, as he says that he has never seen a well-marked 
case of congestion removed by leeches. But the use of the lancet or 
cupping-glasses is very questionable in young children, from the cer- 
tainty of producing crying, which inevitably increases the congestion. 



CONVULSIONS. 81 

Some authors have advised the use of opium and blisters, but such 
remedies are extremely hazardous in very young children. If the child 
is teething, and the gums seem red and swollen, they ought to be scari- 
fied. If there is reason to suspect that worms are the cause, turpen- 
tine should be given in milk, or it may be given in the form of an 
enema. 

After the attack is over, the bowels should be kept regular by mild 
aperients, and the most useful are moderate doses of rhubarb and pot- 
ash, which, besides regulating the bowels, will act as a diuretic. 
Change of air and the use of small doses of chalybeates, along with 
light and nourishing food, will be very beneficial. 

PROFESSOR DUJARDIN-BEAUMETZ, OF PARIS, 

Thus concludes a lecture in the 2V. Y. Medical Journal, 1883 : In 
eclamptic convulsions, or in those which have for their point of de- 
parture reflex action, the best mode of treatment consists in the internal 
administration of bromide of potassium, or chloral, or in inhalations of 
chloroform or ether. All medicaments which ansemiate the brain seem 
to do good in these cases ; it is from this consideration that Trousseau 
proposed compression of the carotids. He warns us to be chary in the 
use of revulsives — such as sinapisms and blisters — in these cases ; for 
severe cutaneous gangrenes, more difficult to cure than the convulsions 
themselves, have more than once been produced by the prolonged 
action of even a mustard cataplasm, and this in consequence of the 
insensibility which results from the fit. 

DR. MEIGS AND PEPPER, OF PHILADELPHIA. 

There are some general rules to be followed in the treatment of con- 
vulsions, which apply to all cases. They are, to place the child in a 
large well-ventilated room, if such can be procured ; if it has been 
seized in a little close room, where the atmosphere is dense and impure, 
removal to another room, or exposure to fresh air before an open 
window, has sometimes sufficed to terminate the crisis. At the same 
time, the clothes should be loosened, in order to prevent all constriction, 
and, if necessary, taken off, to allow of a careful examination of the 
whole body. It is always a good rule, no matter what the cause of the 
convulsion, to place the child in a warm bath (96° or 97° Fah.). If 
the convulsion occur in a strong and vigorous subject ; if it be violent 
and be accompanied by a deep red or livid flush of the face, and dis- 



82 DISEASES OF CHILDREN. 

tension of the viens of the head and neck ; if it lasts more than a few 
minutes or is repeated after intervals of rest, blood-letting is to be 
resorted to. When the convulsion is prolonged or a tendency to .its 
recurrence is manifest, our authors believe that the use of an emetic is 
very desirable, even though no gastric irritation exists, and for this 
purpose, they prefer ipecacuanha. Cold applications to the head are 
useful, when the convulsion is of any considerable violence, but they 
would be improper when the surface is pale, the features contracted, 
and the pulse small and feeble. If the child has been constipated prior 
to the attack, a purgative should be given ; and, in healthy children, 
calomel is the best ; the dose being from two to four grains, according 
to age. It should be followed in one or two hours by a dose of castor 
oil or rhubarb. In most cases purgative enemata will prove of ser- 
vice. They may consist of water, holding in solution castile soap, 
common salt, molasses, castor-oil, sweet-oil, or spirit of turpentine. If 
the first fails to operate in ten or fifteen minutes, another or even a 
+hird ought to be given. Mustard sinapisms (shifted from place to 
place) are very efficacious. They should always be covered with 
gauze or fine muslin, to avoid the danger of leaving any of the mustard 
upon the skin when they are taken off, for our authors once saw very 
bad ulcerations upon the feet of a child from neglect of this precaution. 
Antispasmodics , especially the bromides of potassium and sodium, may 
be used as a means of prevention, in children threatened with convul- 
sions. When there are no evidences of determination of blood to the 
brain, or when it has been removed by blood-letting and revulsives, 
opium proves useful in allaying irritability and restlessness. Somno- 
lence and coma contra-indicate the use of opium. Our authors prefer 
sulphuric ether to chloroform, for the production and maintainance of 
anaesthesia in convulsions. 

THOMAS HILLIER, M. D., LONDON. 

This author considers that in the various forms of infantile convul- 
sions it is of little use to do anything during the attack. The child 
should not be held, but laid upon a mattress, its clothing loosened, and 
plenty of fresh air admitted. A tepid bath is popular and will do no 
harm. When the attacks are frequent and severe, they may be warded 
off by chloroform inhalations. This is, however, a dangerous means, 
and should only be used by the physician himself. It is a real benefit 
only when the attack is impending. 



CONVULSIONS. 83 

To prevent a recurrence, the diet should be carefully regulated, the 
gums lanced if swollen or tender, laxatives exhibited if the bowels are 
costive, anthelmintics if there are worms, etc. The main indication is 
to nourish the child in the best manner possible. Bromide of potassium 
in full doses, iron and tonics, are the medicines chiefly demanded. 

DR. T. K. HOLMES, ONTARIO, 

In a paper in the Transactions of the International Medical Congress 
for 1876, advocated the treatment of convulsions in children accom- 
panied by high temperature of the body, by means of the cold bath. 
He puts the child at first into a tepid bath and then rapidly cools it to 
50° Fah. He never resorts to the bath when the temperature of the 
child is below 100°, and always removes it from the water when the 
axillary temperature has fallen to near the standard of health. Of 
course, where other indications for treatment exist, as malaria, teething, 
irritating ingesta, etc., it is necessary to attend to these also. 

DR. BLANCHEZ, PARIS. 

This writer recommends that when the attacks run into each other, 
or recur at short intervals, revulsives should be applied to the lower 
extremities, compresses of cold water, or of water with ether, being 
also laid on the temples. Compression may at the same time be made 
on the carotid arteries, as recommended by Trousseau. The pulsation 
of these vessels must be sought for at the lateral parts of the neck, and 
then they must be gradually compressed backward toward the spinal 
column. The amelioration should be rapid ; and if after two or three 
minutes it has not manifested itself in an evident manner, the compres- 
sion should not be longer continued. Inhalations of chloroform may 
then be resorted to, administering them in a very gentle and gradual 
manner. In some cases special indications present themselves, a*s for 
the employment of an emetic when it is well made out that the convul- 
sions are due to indigestion. When the attack has been overcome, we 
must try to modify the general eclampsic condition by having recourse 
to anti-spasmodics. Their dose is of great importance. For an infant 
from eight to fifteen months old, we should never exceed the dose of gr. 
iv, after having commenced with gr. j. The maximum dose of belladonna 
powder is gr. iss, after commencing with gr. i, increasing it very 
gradually, and carefully watching the throat and pupils of the child. 
We may proceed more boldly with oxide of zinc, of which gr. iss may 



84: DISEASES OF CHILDREN. 

be given every two hours ; but bromide of potassium and chloral are to 
be preferred to any of these remedies. Of the bromide gr. j-iij may 
be given every two hours, until gr. viij-x are reached in an infant, and 
from gr. xl-1 in a child of seven. 

PROFESSOR JOHANN STEINER, M. D., PRAGUE. 

It is not always easy to detect the cause of infantile convulsions. In 
such cases the causal treatment must give place to the symptomatic. Of 
the various remedies, our author prefers in such instances the following 
combination : 

59. R . Zinci oxidi, gr. iv 

Hydrargyri chloridi mitis, gr. ij 

Saccliari albi, 3J. M. 

Make eight powders. Give one every hour. 

Remove all constricting clothing, apply mustard poultices to the trunk 
and extremities, and use clysters of cold water. The warm bath is 
often serviceable. 

Convulsions from malarial toxaemia demand quinine ; from worms, 
anthelmintics: from phimosis or elongated uvula, excision, etc. 

NOTES ON REMEDIES. 

Amyl Nitrite, Dr. Bridger {Lancet, 1882) says that he has obtained good results 
from the use of nitrite of amyl in the following cases : 1. Convulsions 
resulting from an abscess in the tympanum. 2. From tubercular 
meningitis. 3. From dentition. One-third of a minim in mucilage was 
applied to the child's nostrils every three hours. 

Anaesthetics. Either chloroform or ether, by inhalation, are effective in emerg- 
encies. 

Belladonna is valuable in the constitutional treatment. 

Chloral, in doses of gr. v-x, every six hours, to a child of ten, frequently answers 
the purpose. Dr. Polaillon has administered it with success to child- 
ren as an enema (three grains in five drachms of water.) Calm sleep 
and a cessation of the convulsions follow, and a similar enema given 
twenty-four hours later completes the cure. 

Moschus. When musk can be obtained fresh and pure, it is an admirable anti- 
convulsive agent in children. When the child will not swallow, Dr. 
Jules Simon recommends it in the following enema: 

60. R . Moschi, gr. iij 

Camphorae, gr. xv 

Chloral hydratis, gr. vij 

Vitelli ovi, j 

Aquse, g v. M. 

For an enema ; to be preceded by an ordinary one, to wash out the 
rectum. 



CORYZA. 85 

Opium, in some form, is preferred by many practitioners. It may be adminis- 
tered hypodermically, or by enema, every twenty minutes, until the 
pupils contract. 

Potassii Bromidum, gr. x-5J, is usually a reliable means in idiopathic convulsive 
disorders. Dr. Blanchez {Gazette Medicate, 1875,) recommends a 
mixed treatment, the bromide being given during the day and the 
chloral at night. 

Zinci Oxidum, especially when combined with tonics, aids much in restoring the 
nervous equilibrium. 

EXTERNAL REMEDIES. 

Warm Baths, in infants, often act as potent sedatives. Cold to the head, as com- 
presses wrung out with ice water or dilute ether, is valuable. Trous- 
seau commends pressure on the carotid arteries. (See above.) Of 
course all reflex irritation should be sought for in the first instance, 
and removed. 



CORYZA. 



Simple corjza requires no treatment in children over two years of 
age, except attention to hygienic conditions. In young infants, even 
the mildest coryza gives trouble, by obstructing the full freedom of the 
respiratory act, by interfering with the suckling, and by the restless 
and broken sleep which it induces. In such cases, all the treatment 
required is to keep the child warm, and to clear the nasal passages, and 
at the same time lubricate them by the occasional introduction of a 
camel's hair pencil, charged with diluted glycerine, cosmoline, or sweet 
oil. When the coryza is more severe, quinia even in young infants 
will prove useful ; the dose should be half a grain, twice or thrice 
daily for a child under a year old, and double that amount for a child 
of two or three years. 

In purulent, or pseudo-membranous coryza, the indications of treat- 
ment are to remove the secretions as they collect and to subdue the 
inflammation of the mucous membrane by which they are produced. 
The first indication may be fulfilled by means of a brush made of long 
camel's hair, by throwing water or lime-water from a small syringe into 
the nasal passages, or when the discharges are thin and fluid, by blow- 
ing strongly into the nostrils, whilst the tongue is depressed by a 
finger introduced into the mouth, so as to allow the secretion to pass 



86 DISEASES OF CHILDREN. 

out of the posterior nares into the fauces. The second indication is to 
be* fulfilled chiefly by the application of solutions of alum, nitrate of 
silver, sulphate of zinc or copper, and by insufflations of different sub- 
stances in powder. The best application is probably the solution of 
nitrate of silver, which may be made of the strength of five or ten 
grains to the ounce, or stronger, to be made use of several times a day, 
with a brush. In chronic coryza the treatment must be general and 
local. The general treatment will consist in care as to the clothing, 
suitable diet and the administration of alteratives and tonics. Our 
authors prefer the syrup of the iodide of iron, from three to five drops, 
at four or five years of age, three times a day, in half to one teaspoon- 
ful of syrup of sarsaparilla. When the appetite is poor and the 
digestive process seems slow and feeble, one grain of quinine, three 
times a day should also be given. When the attack is particularly 
obstinate, and when, also, it occurs in a subject who either inherits or 
exhibits signs of the tuberculous or scrofulous diathesis, the best 
remedy is cod-liver cil, which should be given in doses of from half a 
teaspoonful to a teaspoonful two hours after each meal. In cases of a 
syphilitic nature, we should give the iodide of potassium, associated, 
in obstinate cases, with minute doses of bichloride of mercury. The 
local treatment must consist in the use of means intended to keep the 
passage clean and free from scabs and incrustations, and in the employ- 
ment of astringent and alterative applications. When the patient will 
submit, the nasal passages should be cleansed by means of a syringe 
once or twice a day, with tepid water or milk and water, or with a 
weak solution of alum in water (two to four grains to the ounce). If 
the discharges are offensive, we may use chlorinated soda, one, two, or 
three drachms in two ounces of water. The surfaces should be fre- 
quently lubricated with glycerine and cold cream (5j of the former to 
gj of the latter). Amongst the astringent applications, the best are 
weak solutions (gr. ij to v, to water f.Sj) of the nitrate of silver, 
which should be used only once a day, or solutions of the sulphate or 
acetate of zinc with wine of opium. From two to five grains of either 
preparation, with a drachm of wine of opium, to an ounce of water, 
make a proper application. This may be applied twice a day. 

After the use of the alum injection during the day (see above) Drs. 
Meigs and Pepper strongly urge the application of the following oint- 
ment at night : 



C0RYZA. 87 

61. R. Unguent, hydrarg. nitrat., £ss 

Ext. belladonnas, gr. x 

Axungiae, 1 ss . M. 

It should be applied, after being completely softened by a gentle 
heat, on a camel's hair pencil, care being taken to apply it thoroughly 
to the mucous membrane itself, and not merely to the outside of the 
hardened scabs. 

EDWARD ELLIS, M. D., LONDON. 

For ordinary cold-catching and snuffles in children, this writer has 
found no treatment, at the outset, so useful as small doses of spirits of 
camphor, frequently repeated, say every half hour or hour. If the 
cold be more advanced, and what is called " feverish," with hot skin 
and frequent sneezing, tincture of aconite, gtt. J, in water every half 
hour, will speedily cause diaphoresis and a general feeling of relief. 
The lassitude left after a cold, or a cold showing a tendency to become 
chronic, is best met by tinctura nucis vomicce, gtt. ij-v, to a child ac- 
cording to age, three times a day, in a little water. He has frequently 
and thoroughly tested these plans of treatment, and can recommend 
them with confidence. 

PROF. J. LEWIS, M. D., NEW YORK. 

In children, ordinary attacks of this affection require little treatment 
beyond keeping the bowels open ; soaking the feet in mustard water, 
and having the body warmly clothed. Friction with camphorated oil, 
over the nose, is of some benefit. In attacks which commence with 
greater severity, an emetic of syrup of ipecacuanha, given early, will 
moderate the inflammation, and may prevent the occurrence of bron- 
chitis. Afterward, a simple diaphoretic mixture should be adminis- 
tered, such as the following : 

62. R . Syrupi ipecacuanhas, f. % ij 

Spiritus aetheris nitrosi, f.3,i 

Syrupi simplicis, f-^ij« M. 

One teaspooonful every three hours, to a child of six months. 

In place of sweet spirits of nitre, acetate of potash may be employed, 
in the dose of L to 2 grains, for infants. If there is febrile re-action, 
from J- minim to 2 minims, according to the age, of tincture of digi- 
talis, may be given in each dose. 

In pseudo-membranous coryza, the laryngitis which usually accom- 



88 DISEASES OF CHILDREN. 

panies this affection, demands the first attention. The injection of a 
solution of chlorate of potash, in water, several times a day, subdues 
the inflammation and removes the collection of mucus and pus. Or, 
the following may be employed : 

63. R . Pulveris alurainis, gr. xvj-xx 

Aquae, f. 5 iv. M. 

This bromide solution (see Index), diluted as directed, will also be 
found useful when injected into the nostrils. 

Chronic coryza should be treated by tonics and by alteratives, di- 
rected to the cachexia which may be present. Together with such con- 
stitutional treatment, a solution of nitrate of silver (gr. iij-v to f.Sj) 
may be injected into the nostrils. An excellent formula for application 
to parts which can be reached by a camel's-hair pencil, is : 



64. R . Pulveris zinci oxidi, 


3J 




Glycerinae, 


t'-sj. 


M 


To be applied three or four times a day. 






65. R . Liquoris ammonias acetatis, 


f.S.l 




Vini ipecacuanhas, 


m,xvj 




Potassii nitratis, 


gr. viij 




Misturae amygdalae, 


f. 7> vij. 


M 


A teaspoonful every four hours, for a child of six 


months. 





CROUP. 

DR. EDWARD HENOCH, OF BERLIN. 

This author considers that if local bleeding, emetics, tartar emetic, 
the energetic use of mercurials and the application of a blister to the 
region of the larynx, do not produce rapid improvement, nothing can be 
expected from medicinal remedies. He warns us against the frequent 
repetition of emetics in an already exhausted child, because without 
producing any good effects, it increases the inanition to an extreme 
degree, and may lead to serve cerebral symptoms. He also recommends 
that the children be not constantly kept in bed, but frequently carried 
around in the arms, as this produces temporary relief. Broth, milk or 
wine should be frequently, but cautiously given, in order to maintain 
the child's strength. The occurrence of the first threatening attack of 
suffocation or even the forcible action of all the accessory muscles of in- 



croup. 89 

spiration, is, for him, the signal for tracheotomy. Too long delay only 
increases the exhaustion, the danger of carbonic acid poisoning and the 
development of broncho-pneumonia. His experience tells him that the 
chances for the success of tracheotomy are more favorable in simple 
primary than in diphtheritic croup. Even the presence of bronchitis or 
pneumonia does not constitute a contra-indication for tracheotomy, as he 
has seen several such cases recover. It is well to continue mercurial 
treatment to a moderate extent afterwards, and, by the inhalation of 
warm vapor of water through the canula to facilitate the exfoliation, of 
any pseudo-membrane which may still be present on the mucous mem- 
brane. 

DR. ARMAND SEMPLE, OF LONDON, 

Speaking of Spasmodic Croup (Laryngismus Stridulus; Thymic 
Asthma) this author says that it is caused by morbid influences acting 
at a distance from the larynx, such as the irritation of teething, or the 
presence of tumors pressing upon the recurrent laryngeal nerve ; worms 
in the intestines, and unwholesome or unsuitable food, are common 
causes. It is probably, he thinks, in many cases hereditary, and is often 
observed in nervous, tubercular and rickety children. 

The treatment consists, during the paroxysm, in lancing the gums and 
the use of the warm bath. The treatment afterwards should consist in 
the removal of worms, if they exist ; the use of mild aperients or ant- 
acids, or weaning the child, since, in some cases, the milk of the mother 
disagrees. In many cases, however, the disease arises from the removal 
of the infant from the mother's breast, and, in this case a wet-nurse is 
the best substitute. 

DR. WILLIAM PEPPER, OF PHILADELPHIA. 

This author is a great advocate of the use of bichloride of mercury 
(New York Medical Journal, 1884). He uses it in large doses with 
the following rules to guide him. If the false membrane is increasing, 
he increases the drug ; if it is stationary, he maintains the same dose ; 
if it is decreasing, he diminishes the remedy ; and if the membrane has 
disappeared, he at once stops the bichloride. 

He has found it convenient to have two standard formulas, according 
as he wishes to combine iron with the mercury or not. He generally 
writes for a three-ounce mixture, with half a grain of the bichloride, so 
that each teaspoonful contains about one-fortieth of a grain. The fol- 
lowing are his prescription models : 



90 DISEASES OF CHILDREN. 



Formula I. 






66. R. Hydrargyr. bichlor., 
Tinct. ferri chlor., 




gr. ss 


Glycerin., 
Aquae, 


q. 


f. Jss 
s. ad f. 3 iij 


Sig. f. ^j. as directed, in water. 






Formula II. 






67. R. Hydrargyr. bichlor., 
Vin. pepsin., 
Elixir bismuthi, 


aa 


gr. ss 
giss. 



M. 



M. 



Sig. f. 3j, as directed, in water. 



The second formula is the pleasantest way of prescribing the remedy, 
and it is the one used by Dr. Pepper. 

Practically, he now generally begins with the second formula, and, 
when convalescence has commenced, resorts to No. 1 to get the benefit 
of the iron. 

He does not attempt to explain the action of the bichloride ; but bases 
his claim that it will give better results than other treatment known at 
present, entirely on clinical evidence. An important point is that the 
drug should be well diluted, whereby its irritating properties are 
avoided. 

DR. O. T. SCHULTZ. 

This author very highly praises the method recommended by Dr. 
Reiter, of Pittsburgh, which consists in the administration of large 
doses of calomel. He uses it in enormous doses, having given to his 
own child, after the failure of all other remedies and when death 
seemed imminent, as much as eighty-five grains in twenty-four hours. 
Under these large doses the membrane already formed was vomited up 
and the further formation was checked. The child fell asleep, the res- 
piration became natural and the bowels were freely moved. He re- 
cords his experience in The American Practitioner, for May, 1884. 

DR. J. P. KLINGINSMITII, OF PENNSYLVANIA. 

This physician also highly praises the calomel treatment of croup 
and diphtheria, in the Medical Record, 1884. The mercurial used 
was the English calomel, and was given by filling a teaspoon half full 
of cold water, then dropping the medicine upon it, after which it was 
placed well back in the mouth of the patient. The calomel purges, 
but not to excess, causing simply free and copious evacuations of a 
greenish appearance. He has never known ptyalism to occur in a 



CROUP. 91 

single case. His experience with this plan of treatment is based upon 
three cases of his own, besides a number occurring in the practice of 
other physicians. He believes that with a faithful and proper adminis- 
tration of the remedy in question, disintegration and separation of the 
membranes will be facilitated, as well as relief afforded to allay the 
spasmodic character of the disease. 

M. JULES SIMON, OF PARIS. 

This distinguished teacher, who has had great experience in the 
Hopital des Enfants Malades, treats croup as follows: (Medical Press, 
1883.) As soon as the malady is diagnosed, he touches the throat 
with lemon juice or a solution of muriate of iron every two hours. 
Every three hours he washes the part affected with a solution of borax 
(two drachms to the ten ounces). The atmosphere of the room is 
charged with atomized phenic solution, a stimulant nourishment is 
given, and three to five drops of tincture of iron administered every 
three hours. When dyspnoea becomes apparent, an emetic is given, 
but if the symptoms are not relieved, tracheotomy must be performed 
without delay. The after-treatment consists in placing a piece of tar- 
latan over the canula, warming the room and administering beef tea 
and tincture of iron. The removing and cleansing of the canula should 
be done by an experienced person ; it might be definitely removed 
after the eighth or tenth day. M. Simon considers that chlorate of 
potash is of little use in croup. 

DR. CHARLES J. FAHIE, OF ENGLAND. 

This writer states, in the British Medical Journal, 1883, that out 
of ten cases of croup treated as follows, he did not lose one. He pro- 
vides that the case must be seen early. A hot bath, a hot poultice of 
burnt salt to the throat externally, a mustard emetic, and a dose (to be 
regulated according to the age of the child) of the following mixture 
every two hours : tartar emetic, liquor ammoniae acetatis and mistura 
citratis potassse. The citrate of potash mixture can be made by sat- 
urating bicarbonate of potash with citric acid. 

DR. WILLIAM L. MARTIN, OF NEW JERSEY. 

This author (Medical and Surgical Reporter, 1883,) says that 
since adopting the lime inhalation treatment his success has been almost 
uniform. But the lime inhalations will only answer where the deposit 



92 DISEASES OF CHILDREN. 

is that of true croup. He is satisfied from numerous trials that it has 
no effect in the croupous form of diphtheria or diphtheritic croup. 
When seen early, he places much reliance upon small and repeated 
doses of calomel, but the cases must be seen early. 

DR. E. R. DUVAL, OF ARKANSAS. 

This author (Transactions of the Medical Society of the State of 
Arka?isas, 1882) states that for twelve years, after the manner of Dr. 
Fordyce Barker, of New York, he has been using the turpeth mineral 
in the treatment of this disease, and he has, since the adoption of this 
plan, lost no case of croup. 

His treatment has been, immediately upon being called to a case, 
without stopping to interrogate very closely as to whether he had a 
croup reflex, catarrhal, or true croup, to administer at once a dose of 
the agent (from two to five grains, according to age) in honey, syrup, 
or sugar of milk, and if there is no decided emesis within fifteen 
minutes, to repeat the dose ; and he has never known it to fail to pro- 
duce vomiting at the second dose ; almost immediately a satisfactory 
response is secured by the first administration. The vomiting is usually 
free, without effort and without depression. The powder is tasteless, 
small in bulk, prompt in action, and thorough in effect. 

The virtues claimed for it are sedative and revulsive. a It depletes 
the mucous membrane by an abundant secretion of mucus, which is 
thrown up ; it removes from the larynx, by the forced expiration which 
it causes, any albuminous or fibrinous exudation which may be there in 
a diffluent state, and which by remaining may become, subsequently, 
pseudo-membrane ; it acts as a powerful revulsive, and thus diminishes 
the capillary circulation in the trachea and larynx ; and thus it becomes 
a most effective agent in arresting the inflammatory forces." 

If the croup persists after removing the causes of reflex action, then, 
of course, other therapeutic agencies will need to be essayed; but 
throughout the attack, be it short or long, whenever the breathing be- 
comes suffocative, from the accumulation of mucus in trachea or larynx, 
he gives the turpeth mineral in the manner and according to the con 
ditions and plan above designated. 

CATHETERISM OF THE TRACHEA. 

Since it is not always possible to secure the consent of the parents to 
perform tracheotomy, it will be well to bear in mind that a corres- 



croup. 93 

pondent of the British Medical Journal, when placed in such a 
position, where tracheotomy seemed imperatively demanded, yet where 
consent was refused, resorted to the following procedure : He intro- 
duced a large (No. 12) gnm-elastic catheter into the trachea, with less 
difficulty than he had anticipated — having first gagged the child's 
mouth with a cork. After a severe paroxysm, the patient succeeded 
in getting a good breath, and the next expiration was followed by the 
ejection of mucopurulent debris and sticky phlegm through the tube. 
In about ten minutes these convulsive efforts ceased — the child, in the 
meantime, getting a good amount of air into her lungs. In half an hour 
her face was flushed, but had lost its lividity and the breathing was 
fairly comfortable. The tube was retained by tape tied around the 
child's neck, and was removed twenty-four hours after its insertion, 
when the temperature had fallen to 100° F., and the pulse from 150 to 
100. Five days later she had entirely recovered. 

DR. W. MACEWEN, OF GLASGOW. 

Before the International Medical Congress (1881) this author re- 
lated several cases in which he had introduced flexible tubes into the 
trachea through the mouth, and gave one case of membranous croup in 
which their use had been attended with marked success. Dr. Rob- 
ertson, also of Glasgow, confirmed Dr. MacEwen's statements, and 
said that the patients' voices were unaffected, even in the case of the 
patient in whom the tube was retained for thirty-six hours. The 
respiratory murmur seemed quite full and free at the base of the lungs, 
showing that air was freely admitted. There was no difficulty in swal- 
lowing. 

M. T1IIB0N, OF BELGIUM. 

In the Lancette Beige this author becomes quite enthusiastic over 
the therapeutic effects of sulphate of copper. He considers it to be not 
only a very efficient emetic, but also a powerful parasiticide, and there- 
fore of especial value in croup, first causing the expulsion of the false 
membranes and then preventing their reproduction, through its destruc- 
tive action on the vegetable organisms. Practically, he asserts that 
this medicament has given him very satisfactory results in very des- 
perate cases ; it should be given in sufficient doses. Children of two 
years of age have taken over fifteen grains in twenty-four hours with- 
out any toxic effects. He employs the following potion: 



94: DISEASES OF CHILDREN. 

68. R. Cupri sulph., gr. viij 

Aquae, fij. M. 

A teaspoonful should be given every ten minutes, until vomiting is 
induced ; afterwards the same dose may be repeated every hour, and 
later every second hour. 

DR. A. JACOBI, OF NEW YORK. 

Dr. A. Jacobi reaches the following conclusions in relation to this 
subject, (Medical Record, 1884): 

1. The mercurial treatment of pseudo-membranous affections of the 
respiratory organs is promising of great results. 

2. The corrosive sublimate is the preparation best adapted for inter- 
nal medication. 

3. The system must be brought under its influence speedily, by fre- 
quent doses. 

4. It must be given in dilutions of 1 to at least 3000 to 5000. 

5. Babies of tender age bear one-half grain and more a day, and 
many days in succession. 

6. Salivation and stomatitis are rarely observed, and appear to heal 
kindly. Gastro-intestinal disturbances are not frequent ; they are 
moderate, can be avoided by the administration of mucilaginous and 
farinaceous food, or of mild doses of opium. 

7. If not well tolerated, the inunction of sufficient and frequent 
doses of hydrargyrum oleate takes the place of the corrosive chloride, 
either together, or alternately with the internal administration. 

8. The treatment of croup may be preventive to a great extent. 
Most of the cases are complicated with, or descend from, diphtheria of 
the fauces. Here the preventive treatment of croup must begin. 
Without desiring to encourage mere local treatment, which, in unwilling 
patients, has to resort to force or violence, and thereby does great 
harm, he points to the peculiar local effect of mercury on the pharynx, 
both in the healthy and sick, as a means to influence the threatened 
invasion of the larynx. 

DR. W. H. DAY, OF ENGLAND. 

This authority on diseases of children, as the result of long experi- 
ence, lays down the following rules : 

The temperature of the room should not be lower than 65°. 



croup. 95 

1. The vapor bath is indispensable in the treatment of croup, and 
should be used at the commencement in every case, and continued un- 
remittingly until all fear of a relapse has departed. 

2. All cases of croup are invariably relieved by the vapor bath, 
especially if the tracheal membrane is dry ; when it is moist there 
might be fear of causing too much depression. 

3. The earlier that a case comes under treatment, the greater the 
probability of a successful termination, because it is then possible to 
prevent the tracheal secretion becoming organized. 

4. The most trying difficulty we have to contend with in the manage- 
ment of croup in the catarrhal form is a relapse, because with it comes 
exhaustion ; and the weaker the patient the less will be the chance of 
recovery. 

5. Tartarized antimony is our sheet-anchor as a medicinal agent; not 
so much from any specific effect it exerts on the tracheal membrane, as 
from its certainty in effecting free and speedy vomiting. 

6. Tartarized antimony should, however, be mainly given for the 
purpose of producing vomiting ; that failing, it is comparatively useless, 
because, if continued in small doses at intervals, its depressing effect is 
too great. 

7. When the emetic has fully operated, if there be much febrile ex- 
citement and disordered primse vise, which aggravates the laryngeal 
symptoms, a grain of calomel every four hours, or one full dose for 
the purpose of emptying the bowels and controlling the fever, will be 
found necessary. In the fibrinous form, when there is violent and 
acute inflammation, with a firm, hard pulse, and a full reserve of 
strength, two or three leeches may be applied over the thyroid carti- 
lage, and bleeding can easily be arrested by pressure with the finger, 
and if need be, with cotton wool ; then mercury may prove a valuable 
addition to the antimonial treatment. Some cases improve from the 
moment the mercury affects the bowels, the fever diminishing, and the 
expectoration of the false membrane being promoted. When employed 
in small doses at regular intervals it would appear to diminish the 
cohesive attachment to the mucous membrane, and to render the lymph 
less fibrinous and more readily absorbed. 

8. When in a case of croup, seen at an early stage, and satisfactorily 
progressing, forty-eight hours have elapsed, we may generally augur a 
favorable termination; and we should then begin, if not before, to sup- 



96 DISEASES OF CHILDREN. 

port our patients with good beef-tea, milk and arrowroot, and (it may 
be) a little wine and water. 

If after vomiting the temperature remains high, and especially when 
the bowels have acted freely, minim doses of aconite every two or 
three hours are of great service in inflammatory croup. This keeps up 
a gentle diaphoretic action on the skin, diminishes tension of the pulse, 
and controls vascular excitement in a very striking manner. At this 
stage it comes in well, because antimony should not be long continued 
in any of the diseases of children, and it certainly ought not to be in 
this disorder. 

H. V. SWERINGEN, A. M., M. D., FORT WAYNE, IND. 

As a general rule, croup, laryngismus stridulus, attacks the child 
suddenly, in the night, and requires but an emetic to effect its almost 
equally sudden disappearance or removal. But we occasionally meet 
with cases which prove decidedly exceptional to this general rule, and 
which create in our minds the fear that they belong to the true or 
pseudo-membranous variety of the disease. For these cases the follow- 
ing prescription is admirably adapted : 

69. R . Potass, bicarb, 3ij 

Potass, iodid, grs. xvj 

Tr. card, co, 

Syr. simp, aa f.5tj 

Aquas destil, q. s. ad f.^ij. 

M ft. sol 

Sig. A teaspoonful in water every hour until three or four doses are 
taken, then every three or four hours. 

DR. SCARFF, OF MARYLAND. 

This author (Medical and Surgical Reporter, 1880,) gives an 
emetic dose of turpeth mineral, repeated in ten or fifteen minutes, if 
necessary. He follows this with tincture of aconite root or tincture 
veratrum viride, given every hour, watching the effect. Hot sponges 
are applied. If the disease extends, he gives stimulating expectorants 
and in the latter stages, quinine and carbonate of ammonia, in large and 
frequent doses. He never uses calomel. During convalescence, he gives 
chlorate of potassium and quinine, with liquid nourishment from the 
beginning. The room should be moderately warm and not too much 
clothing allowed. Out of thirteen cases of true croup treated on this 
plan, he lost only two. 



croup. 97 

dr. w. c. chapman, of ohio. 
Having produced free emesis, {Toledo Medical and Surgical Jour- 
nal, 187 §,) this physician commences the administration of tincture of 
veratrum viride, preferably Norwood's. The manner of its employment 
should be carefully considered, as success depends more especially on 
close observation of its physiological manifestations. Invariably, in a 
case of true croup, the pulse is high, from 120 to 140, irritable and 
quick. Veratrum viride, will, if given properly, reduce the number of 
the pulsations and decrease the vascular tonus. It should be given in 
small doses, repeated at short intervals. He begins with two drops 
every hour and keeps on until the eifect is noticed in the pulse. This 
is the important point in the treatment. Push the remedy until the 
pulse reaches 60, and keep it there. If there is any bronchial compli- 
cation, as there often is, it is well to order syrup of senega, com- 
bined with paregoric and either the carbonate or muriate of ammonia. 
Quinine, one grain every four hours, should be given, commencing its 
administration immediately after the full effect of the veratrum is 
obtained. 

TRACHEOTOMY IN CROUP. 

See Tracheotomy in Diphtheria, page 176. 

DR. R. W. HUTCHINSON, OF NEW YORK. 

This author thinks {Med. and Surg. Reporter, 1884,) that for the 
present, we must rely more on local remedies, applied by means of one 
of the various apparatus in use to atomize liquids. This must be re- 
sorted to almost uninterruptedly day and night until the symptoms show 
a disposition to yield, and then less frequently. The room in which the 
patient lives should, morever, be kept saturated with steam. He gener- 
ally advises an open vessel to be kept boiling with lime-water. He 
thinks this gives more relief than the simple steam ; so that it is possible 
that the lime has a dissolving action on the membrane. 

DR. C. R. ILLTNGWORTH, OF ENGLAND. 

This practitioner {British Medical Journal, 1884) has had very 
satisfactory results from the internal use of strong astringent remedies, 
and powerful counter-irritants, in the shape of blisters externally. He 
applies the blisters under each angle of the lower jaw, and gives minim 
doses of the perchloride of iron, grain doses of the sulphate of alumina 
7 



98 DISEASES OF CHILDREN. 

and two minim doses of the tincture of belladonna every two hours, 
sweetening the mixture with glycerine. 

PROF. FORDYCE BARKER, M. D., NEW YORK CITY. 

This teacher always commences treatment by the following emetic 
of turpeth mineral : 

70. R . Hydrargyri sulphatis fiavae, gr. iij-v. 

For one dose. If it does not act in fifteen minutes, give a second dose of 
three to five grains, according to the age of the child. This, however, is 
rarely necessary. 

If, on the next visit, he finds the child with a quick pulse, hot skin, 
somewhat hurried breathing, and an occasional ringing cough, but with 
no thoracic rales, he directs that it shall be kept quiet in bed, com- 
fortably covered, but not with too many clothes, and prescribes the 
veratrum viride, in one or two-drop doses, according to the age of the 
child, as, for example, in the following formula: 

71. R . Tincturae veratri viridis, gtt. xvj-xxx 

Spiritus aetheris nitrosi, f. 3y 

Syrupi simplicis, f.^j 

Aquae, f.^vj. M. 

A tablespoonful everj second hour. 

He visits the child at least as often as every eighth hour, and in- 
creases or diminishes the dose, according to the effect of the medicine 
on the pulse. He is not satisfied until the pulse is below eighty per 
minute, and then continues the veratrum in half the dose that was nec- 
essary to bring it down to that point. If thoracic rales, hurried and 
labored respiration, and other symptoms indicate that the disease is 
extending downward, then substitute for the above prescription some- 
thing like the following formula, of course varied according to the 
special indications of the case : 

72. R . Tincturae veratri viridis, gtt. xvj-xxx 

Ammoniae carbonatis, 3 SS 

Syrupi tolutani, 

Syrupi acaciae, aa f.^j- M. 

A teaspoonful every second hour. 

Sometimes, on account of increasing laryngeal and bronchial obstruc- 
tion, the emetic of turpeth mineral should be repeated on the second or 
third day, but it is not necessary or well to repeat it a third time. 



croup. 99 

Quinine is a remedy of great value, and well tolerated in large doses 
in some of the diseases of the respiratory organs of children. It is of 
great service in some cases of croup in the advanced stages, when the 
respiration is hurried and irregular, and paroxysms of cough becoming 
less marked, the intermissions less distinct, and the cough husky instead 
of ringing. Our author then substitutes for the last formula the follow- 
ing: 

73. R . Quiniae sulphatis, 

Ammonise carbonatis, aa gss 

Syrupi senegae, 

Syrupi acaciae, aa f. g j. M. 

To be well shaken. A teaspoon ful every fourth hour. 

When the croup is complicated with lobular pneumonia, give the 
quinine separately, 4 or 5 grains three times a day, while the little 
patient takes the last of the prescriptions containing veratrum viride. 

HERMAN BEIGEL, M. D., ETC., LONDON. 

Dr. B. recommends in a case of croup the use of the following medi- 
cated sprays, given in the order of their value. They are applied by 
means of the atomizer : 

74. R . Aquae calcis, f. ^j. M. 
For one inhalation, lasting about a quarter of an hour, and to be repeated 

every two hours as long as bad symptoms are present. 

A convenient method is to pour hot water on unslaked lime in a 
pitcher, and to have the patient inhale the vapor as it arises. 

75. R . Acidi tannici, gr. ij-xx 

Aquae, f.^j. M. 

For one inhalation, to last fifteen or twenty minutes. 

76. R . Potassii bromidi, gr. v-x 

Aquae, f. gj. M. 

This inhalation, at the early stage of the disease, will often be found 
to arrest the symptoms. 

With these inhalations the administration of emetics or other remedies 
may be combined. 

DR. FELIX VON NIEMEYER, PROFESSOR UNIVERSITY OF TUBINGEN. 

77. R . Cupri sulphatis, gr. x-xv 

Aquas, f.gij. M. 

A large teaspoonf ul to be taken evei y five minutes until vomiting sets in . 



100 DISEASES OF CHILDREN. 

In regard to the employment of emetics in croup, Prof. N. thinks 
that they are only indicated when obstructing croup-membranes play a 
part in producing the dyspnoea, and when the child's efforts at cough- 
ing are insufficient to expel them, Impeded expiration is an indication 
for their employment. 

Sulphate of copper is preferable to tartar-emetic or ipecacuanha. It 
should be given in full doses ; in small ones it is uncertain, and more 
apt to operate as a poison. 

If the bowels be confined, administer a clyster, so that the diaphragm 
may have room to act. The best is a cold one, as follows : 

78. Be. Acidi acetici diluti, f-^ij 

Aquae. f-3 v J- M. 

If, however, there is no remission, notwithstanding the employment 
of the emetic and the cold application, apply the following concentrated 
solution, at intervals of several hours, to the entrance of the glottis : 

79. R . Argenti nitratis, 3 ss 

Aquae destillatse, f-^ij. M. 

Dip a curved rod of whalebone, with a small sponge made fast to its 
lower end, into this solution, press down the tongue of the child, and 
eudeavor to reach the entrance of the glottis with the sponge. There 
the sponge is immediately compressed by the muscular contraction 
which takes place, whereby certainly a portion of the liquid, if only a 
small one, arrives at the larynx. Administer also half a grain of 
calomel every two hours. 

Should this treatment remain without effect, proceed at once to 
tracheotomy. 

Besides treating the dyspnoea upon the principles given above, it 
may be necessary to relieve the paralytic symptoms due to blood- 
poisoning by carbonic acid. For this purpose the powerful stimulus 
obtained by pouring cold water upon the child while in a warm bath is 
of great service. Lose no time in making use of it, the moment the 
child begins to grow drowsy, the skin to cool, the sensorium to be be- 
numbed, or as soon as emetics fail to act. A few gallons of cold water, 
poured from a moderate height, over the head, nape and back of the 
child, almost always cause it to revive for a while and to cough vigor- 
ously. Thus, sometimes, after the bath, masses of exudation are ex- 
pelled. Other stimulants, such as camphor or musk, are much less 
effective, and ought not to be employed, save when insuperable objec- 
tions are opposed to the cold affusion. They should be given in large 



CROUP. 



101 



doses, immediately prior to the emetic, 
be used: 



The following formula may 



80. R. 



C amphorae, 
iEtheris acetici, 



gr. x 

Ten to fifteen drops to be given every quarter of an hour. 



M. 



PROFESSOR J. LEWIS SMITH, M. D., ETC., NEW YORK. 

81. R. Potassii chloratis, 3j 

Ammonii muriatis, J}ij 

Syrupi simplicis, f. ,^j 

Aquae, f. jfij. M. 

One teaspoonful every twenty minutes to half an hour, or in cases not 
severe, every two hours. This should be continued regularly, night 
and day, until the cough becomes looser, or until it is evident, if the 
case be unfavorable, that it can be of no service. 

The atmosphere the child breathes should be constantly loaded with 
moisture, without, however, that degree of heat which would add 
materially to the discomfort of the patient or attendants. The tem- 
perature should be of 75° or 80°. 

Besides the nitrate of silver, three other substances have been used 
of late years, for the topical treatment of the throat, which appear to 
be more effectual in removing the pseudo-membrane, and controlling 
the inflammation. One is liquor ferri subsulphatis ; the second, car- 
bolic acid, and the third, bromine. The following formulae may be 
used : 



82. R 



Liquoris ferri subsulphatis, 
Glycerinae, 



83. R . Acidi carbolici fluidi, 

Aquae, 

84. R . Brominii, 

Potassii bromidi, 
Aquae, 



f-3J 

f.gss. 

f.Bvj. 

gr. xlv 



M. 



M. 



M. 



This is called the bromine solution ; but it must be considerably 
diluted for use. Twenty-four to forty drops should be added to an 
ounce of water, for application to the fauces or larynx. Our author 
most highly recommends the sulphate of iron solution. 



DR. J. J. HIGGINS, NEW YORK. 

The special indications in croup are laid down by this writer (The 
Practitioner, May, 1877,) as follows: 



102 DISEASES OF CHILDREN. 

1. The relief of spasm. For this purpose, emetics are demanded. 
The best is turpeth mineral (hydrargyri sulphas flava), gr. iij, for 
children from one to three years of age, repeated once in six or eight 
hours, if necessary. 

2. The relief of congestion and inflammation. To accomplish this, 
aconite is the most efficient remedy, in small, oft-repeated doses, gtt. J 
to a child of four years. 

85. R. Tinct. radicis aconiti, gtt. vj. 

Syrupi ipecacuanhas, 

Spiritus aetheris nitrici dulcis, aa f. 5 ij. 

Aquas carui (vel anisi), f. ^ ij. M. 

A teaspoonful for a child of two years. 

A sinapism to the upper part of the thorax, aids the remedy. 

3. The dissolution and expulsion of the membrane. This may par- 
tially be done by emetics ; but the real reliance must be on calomel, in 
full doses, gr. x-xx. These large doses are absolutely necessary to 
check the disease. The administration of mercury in small doses, 
does not do this ; it simply eifects an augmentation of the secretions ; 
and, again, neither does the disease last for such a length of time that 
the constitutional effects of mercury could be got, nor, as a rule, could 
such effect in the infant be obtained. In larger doses of from 5 to 10 
or 20 grains, mercury acts in a totally different way ; and, when so 
given, exerts a powerful influence upon the disease, of a sedative and 
salutary character. Dr. Elliotson also strongly and earnestly advo- 
cates this course, and says, "There is extreme danger here, and, there- 
fore, mercury should be given with the greatest freedom." 

NOTES ON REMEDIES, 
Acetum. The fnmes of vinegar are highly extrolled by Dr. Lesdorf. {Doctor, 
Nov., 1875.) He directs that when, after emetic doses of sulphate of 
copper, the dyspnoea seems not to yield, a vapor-bath is to be given, as 
follows : A wooden vessel, containing eight to ten quarts of hot water, 
half to three-quarters of a pint of vinegar, and a handful of meal, is to 
be placed at the foot of a child's bed ; a quilt is then to be suspended 
over the bed, so that one end is to cover the vessel, and the other so ar- 
ranged that the vapor, in escaping, must pass over the child's head. A 
red-hot iron is then to be placed in the vessel, and left there so long as 
it developes the hot acid vapor. This bath is to be repeated every two 
hours, night and day, while there is any danger. The very best result* 
may be anticipated from this method of treatment, and operative inter- 
ference, even in acute cases, may often be prevented by energetically 
carrying it out. 



CROUP. 103 

Acidum Lacticum, as a solvent of false membrane in croup, is highly esteemed. 
The following is the formula of the London Throat Hospital: 

86. R. Acidi lactici, ^ ss. 

Aquae destillatse, f. % x. M. 

Use with an atomizer. 

Alumen was the favorite emetic in this disease, with the late Prof. Charles D. 

Meigs. He gave 5 j in molasses or honey, as required. 
Antimonii et Potassii Tartras is still preferred as an emetic by some. Dr. Ellis 

prescribes : 

87. R. Antimon. et potassii tartratis, gr. ij 

Oxymellis scillae, 

Aquas, aa f.gj. M. 

Two or three teaspoonfuls every quarter of an hour, in the early 
stages of croup, to a child four years old. 

Apomorphine is effective, but highly dangerous, as it exerts a paralyzing action 

on the respiratory organs. 
Prof. Dujardin-Beaumetz recommends its use as an emetic, the 

dose being from ^ to y 1 ^ of a grain. 
Argenti Nitras, dried and pulverized, and mixed with sugar, has been used for 

an insufflation in membranous croup, by Dr. Guillon, of Algiers. 

Belladonna has considerable value in spasmodic croup. Atropia, hypodermi- 
cally, gtt. iij of a one per cent, solution, has been used successfully by 
Dr. DePontives. (Union Medkale, 1878.) 

Brominium is recommended by Dr. Redenbacher. (Med. Cent. Zeit., 1879) : 

88. R. Brominii, gtt. v 

Potassii bromidi. % j 

Decocti althese, ,f iv. 

Syrupi simplicis, §j. M. 

A dessertspoonful to a child of seven years. 

Calx. The odor from slacking lime, and lime-water as a gargle, are both val- 
uable remedies. (See above. ) 

Chloral Hydras has been highly extolled by Dr. William Stewart, in spas- 
modic croup. (Lancet, May 25th, 1878.) He claims it to be the remedy 
par excellence. 

Collodium Caniharidatum. In severe croup of diphtheria, when emetics give 
no relief, Dr. Musicatjtoff, of Warsaw, has found repeated outward 
applications of cantharidal collodion to the throat to yield very suc- 
cessful results. (Dobell, Reports on Diseases of the Chest, 1876.) 

Cupri Sulphas is one of the best emetics in croup. To a child a year old, gr. £, 
in some sweetened water, till emesis is produced. 

Ferrum, in almost any of its preparations, is useful in strengthening the system 
and diminishing the excessive nervous sensibility which is so constantly 
a cause of laryngismus stridulus. 



104 DISEASES OF CHILDREN. 

Hydrargyri Chloridum Mite, in large doses, is recommended on good authority. 
Hyoscyamus is an excellent sedative. Dr. Da Costa recommends : 

89. R . Extracti hyoscyami fluidi, ttliij-x 

Aquse destillatae, f. ^ j. M. 

Used as an inhalation in spasmodic croup. 

Oxygen inhalations are highly lauded by Dr. Joseph B. Potsdamek in the 
Medical and Surgical Reporter, 1880. 

Petroleum Rectificatum, or kerosene, in doses of f. 3 j-iv, is a popular and suc- 
cessful remedy in croup. (See Medical and Surgical Reporter, April 
14th, 1877.) 

Potassii Chloras. Dr. J. F. Meigs speaks highly of this drug, which he com- 

Potassium Iodidum. Dr. Taylor, of Baltimore, speaks highly of this drug, in 
bines with ferric chloride, 
large doses (fifteen grains every two hours.) 

Potassium Chloratis. 

90. R . Potassii chloratis, gr. v-x 

Tinct. ferri chloridi, ttlhj-v 

Syrupi, f. 3 ss 

Aquae, f. 3 ij . M. 

This much every three or four hours. 

* Quinice Sulphas, given in the largest doses the child can bear, and during the 
intervals of the paroxysms, is a very satisfactory remedy, especially in 
weak and obviously nervous infants. 

Valerian is highly recommended by Dr. G. Hill {British Medical Journal, April 
11th, 1868,) who, however, neglects to mention the preparation and 
dose he employed. Dr. Ellis recommends in spasmodic croup : 

91. R. Tinct. valerian, ammon., tt\,v-x 

Tinct. cam ph. comp., tt\,v 

Spiritus chloroformi, rt\jij 

Aquae anethi, f. 3 ij. M. 

For one dose. 



CYANOSIS FEBRILIS PEENICIOSA. 

DR. F. WINKEL, OF GERMANY. 

Under the more comprehensive title of cyanosis febrilis enterica 
pemiciosa cum hoemaglobinuria, this author describes in the Deutsche 
Med. Woch., 1879, a hitherto undescribed disease among new-born 
infants. The rate of mortality among the twenty-three children that 
were attacked was 82 per cent., and the average duration of the dis- 
sease in the fatal cases thirty-two hours. The disease usually made its 



DENTITION. 105 

appearance on the fourth day, but occasionally also on the first, and in 
one case as late as the twelfth. The children were all strong with the 
exception of a pair of twins, and only five had been fed artificially. 
The mothers all remained healthy. The chief symptoms were debility, 
cyanosis and icterus ; the urine contained epithelial casts and blood cor- 
puscles w T ith detritus, and also urate of ammonia, and a small quantity 
of albumen. The stools were free and ochre-colored. There was no 
fever ; on the contrary, the temperature fell ; the colorless blood cor- 
puscles increased in number, and the blood contained large masses 
of detritus of red corpuscles, with other minute bodies of molecular 
motion. The abdomen was soft and not tender, the liver pushed a little 
upward, and the organs of the thoracic cavity unchanged. In the 
course of the disease convulsions set in, with strong jerkings of the 
ocular muscles, convergent strabismus and rotation of the eye-ball. 
The oetiology is obscure and the treatment must be symptomatic. 



DENTITION. 



DR. EDWARD HENOCH, OP BERLIN. 

This author adverts to the fact, that in the opinion of the majority 
of physicians teething is a physiological process that cannot give rise 
to any morbid phenomena, and expresses his conviction that it is ques- 
tionable whether such a decided negation is always justifiable. He 
considers it conceivable that this slow process may have an irritating 
effect upon the dental branches of the trigeminal nerve, and give rise to 
reflex symptoms not only in motor, but also in vaso-motor nerves. He 
mentions cases in which partial spasms of the throat and neck muscles 
were undoubtedly connected with the perforation of a group of teeth. 
The undeniable fact, also, that obstinate vomiting, diarrhoea, or even a 
spasmodic cough, which have resisted all treatment, suddenly disappear 
as soon as one or a few teeth have passed out of the alveolus, can only 
be explained by reflex stimulation of peristalsis or of the vagus, start- 
ing from the dental branches of the fifth nerve. The question of lanc- 
ing the gums to aid dentition is answered negatively by our author, who 
is convinced of its entire inutility, and thinks that the cicatrix which 
results may even hinder the passage of the tooth through the gums. 



106 DISEASES OF CHILDREN. 

DR. ARMAND SEMPLE, OF LONDON. 

This author agrees with Dr. Henoch that dentition does cause de- 
rangements of other and various parts of the body, though he depre- 
cates the ideas of some who would attribute to this process nearly all 
the. disorders arising at this time. He believes that any malady con- 
tracted at this period, such as whooping cough, measles or bronchitis, 
is increased in severity, and any disease to which the child may be pre- 
disposed is liable to development. 

JAMES E. GARRETSON, M. D., D. D. S., OF PHILADELPHIA. 

The diseases associated with the first dentition are the following: 
1. Localized Stomatitis, associated with the eruption of the teeth. 
When tumefaction of the gum is dependent on this tooth eruption and 
the child is in a healthy condition, a certain evidence is found in the 
glistening character of the swelling ; the part immediately over the 
tooth looks tense and feverish. This tense look may under all circum- 
stances, be esteemed an indication demanding the use of the lancet. 
Much relief may also be afforded by applying tincture of belladonna to 
a gum thus congested ; or a saturated solution of bromide of potassium. 
In unhealthy conditions the glistening referred to is not commonly 
present ; and then relief from lancing is but gradual and inconsiderable. 
Stomatitis associated with the strumous, scorbutic or syphilitic cachexia, 
must be treated with reference to these general conditions. In syphi- 
litic stomatitis the following combination exerts a very happy effect: 

92. R . Hydrargyri chloridi corrosivi, gr. j 

Potassii iodidi, 3 j 

Syrupi ferri pyrophosphatis, f. ^ iv. M. 

From a quarter to half teaspoonful, according to age, three times a day. 

An admirable local application for the syphilitic sore mouth and throat 
is the following : 

93. R . Acidi sulphurici aromatici, f. Z ij 

Argenti nitratis, gr. vj 

Infusi querci albi, f-S v J- ^. 

For local use. 

In a scrofulous or syphilitic child general hygienic surroundings are 
very important. To prevent constipation olive oil may be given, q. s. 
When the kidneys fail to eliminate, small doses of sweet spirits of nitre 



DENTITION. 107 

are called for ; when the kidneys are irritable, a cold decoction of buchu 
is excellent. 

94. R. Buchu, £j 

Aquas, Oiss. M. 

Simmer to a pint. When cool, strain, and give a teaspoonful four to six 
times a day. 

Inflammation of the fauces, angina simplex, is a not unusual exten- 
sion of the stomatitis. If it becomes obstinate, three or four Swedish 
leeches may be applied to the upper part of the throat. Hot pediluvia 
and a saline cathartic (a teaspoonful of Epsom salts in a wine-glassful 
of water) are valuable accessories. An emetic dose of syrup of ipeca- 
cuanha will not unfrequently break up a sthenic sore throat. When 
the system sympathizes and there are general febrile manifestations, the 
following combination will be found happily adapted to the case : 

95. R . Liquoris potassas citratis, f. ,^iij 

Spiritus setheris nitrosi, f. % ss 

Pulveris antimonii et pot. tart., 

Morphias acetatis, aa gr. j. M. 

For an infant of one year 5 to 8 drops every two hours. 

When the angina becomes chronic, with feelings of tickling and raw- 
ness in the throat, gum arabic and jujube troches may be held in the 
mouth and allowed slowly to dissolve. 

Or a gargle compounded as follows may be used ad libitum : 

96. R . Tinctures iodinii composite, gtt. xl 

Acidi earbolici, gtt. vj 

Glycerines, f. g j 

Aquas, f. % vij. M. 

For a gargle. 

Brushing the parts with the tincture of belladonna or with a saturated 
solution of the bromide of potassium is sometimes found to abort the 
trouble very speedily. A red pepper gargle or lotion is often valuable. 

97. R . Tincturae capsici comp. , f . % ss 

Aquas, f. gviij. M. 

For a lotion. 

When local measures fail, the physician must address his remedies to 
the constitution. Scrofula or syphilis may be suspected. 

2. Dental Irritative Fever. — This sometimes appears when there is 
no evidence of local inflammatory action about the gums. Of course, 



108 DISEASES OF CHILDREN. 

if these are tense, they should be incised ; if this is not called for, gen- 
eral measures are resorted to. Lemonade, prepared with crushed ice, 
to which bicarbonate of potash may be added, is a grateful refrigerant. 
Or a refrigerating mixture may be prescribed as : 

98. R . Liquoris potassae citratis, f. ^ iij 

Potassii bromidi, 3J 

Aquae, f.^j. M. 

A teaspoonful as required. 

Sponging the skin with water or alcohol, and bathing the wrists 
with cold water are soothing measures. Single-drop doses of veratrum 
viride, or tartar emetic, gr. **&, in iced lemonade, are useful in sthenic 
conditions. 

3. Diarrhoea. — Frequently, to cure a diarrhoea, or an attack of 
cholera infantum, all we have to do is to cut down upon a confined 
tooth. When this fails, either the lining membrane of the digestive 
canal has passed into a state of chronic irritation, or the diarrhoea has 
some other cause. In either event we might prescribe : 

99. R. Olei olivaB, f. jj 

Tinct. opii camphoratae, gtt. v-x. M. 

This amount every few hours. 

Heating applications to the abdomen are very useful, as a spice 
plaster or mild sinapism. A very good combination to direct the irrita- 
bility to the surface and thus relieve the affected parts, is : 

100. R . Spiritus aetheris nitrosi, f. ^ ss 

Liquoris potassae citratis, f»5\j 

Antimonii et potassii tartratis, gr. £. M. 

Ten to fifteen drops every two hours. 

When the diarrhoea has nothing inflammatory about it, the bromide 
of potassium, in 5-grain doses, acts most satisfactorily. The following 
combination is a valuable one, when other sources of irritation, not 
perhaps thoroughly appreciated, exist in conjunction with the dental 
trouble : 

101. R. Hydrargyri chloridi mitis, gr- ij- 

Pulveris opii, 

Pulveris ipecacuanhas, aa gr. j. 

Magnesiae carbonatis, gr. xij. M. 

Make eight powders ; one after each operation, if profuse ; or every two, 
three, or four hours. 



DIABETES MELLITUS. 109 

4. Spasms. The indications, when this complication arises, are to 
remove the irritation by lancing the gums, and to soothe and quiet the 
nervous system. For the latter, we may give the bromide of potas- 
sium, gr. v, as required ; or the tinctures of valerian and gentian, equal 
parts, gtt. x, as required, or the excellent combination recommended by 
Dr. Chambers: 

102. R . Potassii bromidi, 

Tincturae cantharidis, aa gtt. iij. 

MisturaB camphorae, gtt. x. M. 

In a little water as often as needed. 

When such measures as these do not relieve the convulsions, they 
may be presumed to have a deeper seat than dental irritation. 

5. Eruptions. The consideration of dental irritation in infantile skin 
diseases is most important. Such irritation does not, in any manner, 
develop or create the distinctive features in a skin disease, but simply 
by exhausting the system, gives an opportunity for the eruption to 
break out. Its treatment must be that appropriate to its particular 
form, with what is additionally required by the irritation from the 
tooth. 



DIABETES MELLITUS. 

M. BERGESIO, OF ITALY. 

This author says (Archiv. di Patol. Inf. 1884,) that though rare in 
the period of infancy, this disease does sometimes occur. It is more 
frequent among females than among males. The prognosis will be un- 
favorable in inverse ratio to the age, very young children being some- 
times unable to undergo the reparative process. The treatment may be 
more radical than is usually possible with adults, because of our ability 
to entirely exclude farinaceous foods. Some of the preparations which 
are favorably mentioned on account of their curative influence are the 
wine of quinquina, hydrochloric acid (Bouchut), alkalies, either in 
powder or in liquid solution (Gerhardt, Guesinger, Von Altenbrenner), 
sulphate of iron (Heine), opium and its alkaloids (Rollo, Franck, and 
Tommasini), glycerine, and cod-liver oil. Anti-diabetic diet can be 
modified, but the author prefers a milk diet for patients under two years 



110 DISEASES OP CHILDREN. 

of age. After weaning they may receive soup with yolk of egg, and 
certain vegetables and fruits, as cabbage, cherries, strawberries, almonds, 
etc. 



DIARRHEAL DISORDERS. 

S. HENRY DESSAU, M. D., NEW YORK CITY. 

This specialist in diseases of children gives his treatment of infantile 
diarrhoea, as follows : 

In cases of simple diarrhoea occurring in teething children, where 
there is no fever present, and absence of pain on pressure over the 
abdomen, he generally administers a sedative, such as the bromide of 
potassium, in doses of gr. ij-iv every three hours, and insists upon 
careful attention to the diet of the child. If an astringent is found 
necessary : 

103. R . Mist, cretse, f. 3 j 

Tr. catechu, 

Tr. opii camph., a a gtt. ir. M. 

This much every three hours. 

When the patient has acquired a mixed dietary and presents the same 
symptoms of simple diarrhoea as before mentioned, the case being due to 
eating of improper food, if seen shortly after the commencement of the 
attack : 

104. R . 01. ricini, 

Syr. rhei aromatici, aa f. ^ss 

Sodse bicarbonatis, gr. ij. M. 

To be taken every half hour until the bowels have been freely evacuated, 
and afterwards to be taken twice or three times daily. 

Where the stools present the condition of lientery, a tonic of quinige 
sulph. and tr. ferri chlorid. is given, together with 8 to 10 grs. of pep- 
sin, taken with the food at meal time. Pepsin is also given in those 
cases of simple diarrhoea in growing children, where the stools are large, 
watery, frothy and of foetid odor. 

Where simple diarrhoea is met with in strumous children, he pre- 
scribes : 

105. R . 01. morrhuae, f. 5j iij 

Syr. prun. virg., 

Liq. calcis, aa f. J j. M. 

One or two teaspoonfuls after each meal. 



DIARRHEAL DISORDERS. Ill 

When change of temperature, commonly termed cold, is the cause of 
the diarrhoea, by some writers styled intestinal catarrh : 



106. 



R. Tr. opii camph., gtt. iv 

Ext. ipecac, fl. gtt. \. M. 



Given in a teaspoonful of equal parts of syrup and water, is pre- 
scribed for infants, and larger doses for older children. The castor oil 
mixture answers fully as well in such cases, and is more frequently 
given than the first-mentioned combination. 

For summer complaint, appearing in a child undergoing dentition, 
where the evacuations are frequent and present the familiar green or 
chopped-spinach appearance, and also containing mucus and undigested 
curd, all more or less certain indications of inflammatory destruction ; 
and when, moreover, during the first days of the complaint, it is at- 
tended with marked fever and tenderness upon pressure over the abdo- 
men, and more especially in the region of the iliac fossae, he at once 
places the child upon an antiphlogistic treatment : 

107. R. Liq. ammon. acet., or 

Liq. potass, cit., gtt. xx 

Tr. opii camph., gtt. iv-x 

Ext. ipecac, fl. gtt. £-£. M. 
To be given in a teaspoonful of anisette water. 

The diet is to be carefully regulated, the breast to be given not 
oftener than every three hours, and if there be much vomiting, tea- 
spoonful doses of toast-water, containing ice, to be given. In cases 
where vomiting appears as the principal symptom : 

108. R . Hydrarg. chlor. mit., gr. j 

Sacch. albi, gr. xv. M. 

Make sixteen powders . One to be given every two hours. 

When the disease has progressed for several days, until the febrile 
symptoms have subsided, or where such changes appear in the evacua- 
tions, as before remarked, following a previous simple diarrhoea, he 
employs : 

109. R . Pulv. rhei, gr. vj 

Pulv. ipecac, co., gr. x 

Sodii bicarb. . gr. xij . M. 

Make twelve powders. One to be given every three hours to a child 
under one year of age. 



112 DISEASES OF CHILDREN. 

He sometimes uses the following, for the same age : 

110. R. Vin. ipecac, gtt. ij 

Tr. calombse, gtt. xx 

Mist, salinse, f. 3 i j . M. 

To be given every three hours. 

The mist, saline is made by adding lemon juice in sufficient quantity 
to neutralize 20 grains of carbonate potassa dissolved in f. 5 j water. 
In addition to drugs and attention to diet, he generally recommends a 
hot bath to be given twice daily, and the baby to be wrapped in a 
blanket, after being dried, so as to invite free perspiration. 

When this variety of diarrhoea presents itself in children over a year 
old, and in those under that age, also, where there are streaks of un- 
altered blood in the stools, he uses : 

111. R. Bismuth, subnit., gj 

Pulv. ipecac, co., gr. xx 

Pulv. zingib., gr. iij. M. 

Make twelve powders. One to be given every three or four hours. 

Where the disease has lasted for several months, and has assumed all 
the features of a chronic diarrhoea, whether the patient has completed 
dentition or not, he gives the cod-liver oil mixture before mentioned, 
(F. 105, )in the proportion of f. giijss to f. gss, of the syrup ferri 
iodid., a teaspoonful of which is to be given three times daily. It acts in 
the same beautiful and pleasing manner as in the simple diarrhoea of 
strumous children. 

JAMES S. HAWLEY, M. D., GREEN POINT, N. Y. 

In infantile diarrhoea, the indications are as follows : First, to remove 
all sources of irritation from the quantity or quality of the ingesta or 
change of temperature. Second, to allay irritation by sedatives, of 
which the best are the preparations of opium and salts of bismuth. 
When irritation without pain exists, bismuth most promptly and satis- 
factorily allays it; but when accompanied with pain, the addition of a 
minute portion of opium becomes a necessary complement to its effec- 
tiveness. Thirdly, artificial digestion, by the administration of pepsin. 

112. B . Pulveris pepsinae Americanse, 

Bismuthi subnitratis, aa 3J • M. 

For ten powders. One to be given every three or four hours, to a child a 
year old. 



DIARRHEAL DISORDERS. 113 

Opium may be combined, if desired. 

THOMAS HILLIER, M. D., F. R. C. P., ETC., LONDON. 

113. R . Acidi gallici, gr. xij 

Tincturae cinnamomi, f. 3 i ss 

Tincturae opii, Tr\, viij 

Aquae carui, q. s. ad f. § ij M. 

Two teaspoonfuls for a child two years old, with chronic diarrhoea and 
irritable stomach. 

114. R. Oleiricini, f.^ij 

Pulveris acaciae, 5 j 

Tincturae opii, Tr^viij 

Syrupi, f.gij 

Aquae carui, q. s. ad f. Jij. M. 

A teaspoonful for a child six years old. 

A useful oleaginous mixture in dysenteric diarrhoea. 

DRS. MEIGS AND PEPPER, PHILADELPHIA. 

These writers recommend, in the treatment of simple diarrhoea in 
childhood, sulphate of magnesia combined with laudanum, as follows : 

115. R. Magnesiae sulphatis, 3j 

Tincturae opii deodoratse, gtt. xij 

Syrupi simplicis, f. ^ss 

Aquae menthae, f. gijss. M. 

At one or two years, a teaspoonful every two or three hours. For older 
children, the proportion of magnesia and laudanum should be doubled. 

If this fails, recourse must be had to an astringent. The officinal mis- 
tura cretse must be given in teaspoonful doses, after each loose evacua- 
tion, three or four times a day ; or tincture of krameria may be added, 
thus: 

116. R. Tincturae krameriae, f. 3 j-ij 

Misturae cretae, f. 3 ij. M. 

Teaspoonful repeated as above directed. 

They also commend the aromatic syrup of galls : 

117. R . Pulveris gallae optimi, ^ ss 

Pulveris cinnamomi, g ij 

Pulveris zingiberis, ^ss 

Spirituus vini gallici optimi, Oss. M. 

Let the ingredients stand in a warm place for two hours, and then burn 
off the brandy, holding some lumps of sugar in the flames. Strain 
through blotting paper. Fifteen to forty drops, three or four times a 
day, or, when the discharges are very frequent, every two or three 
hours. 

8 



114 DISEASES OF CHILDREN. 

In the chronic form of simple diarrhoea, they have found, of late 
years, the following tonic very useful : 

118. R • Tincturae nucis vomicae, f. 3 ss 

Tincturae gentianae compositae, f. giij 

Syrupi simplicis, f. 3 v 

Aquae, f . 3 ij . M. 

A teaspoonful three times a day, after meals, for children of three or 
four years of age. 

Wine of pepsin is also efficacious in such cases, in doses of J tea- 
spoonful thrice daily. 



This physician positively prohibits cow's milk in intestinal catarrh. 
He states that penciling of the mouth with laudanum, and the use of 
opiate clysters, stand at the head of all therapeutic measures. But, 
occasionally, in the profuse diarrhoea of summer, opium proves ineffica- 
cious ; then order small doses of calomel, gr. J, three or four times 
daily, or: 

119. R . Argenti nitratis, gr. ss 

Aquae destillatae, t.%i\j. M. 

A teaspoonful three or four times a day. A drop of laudanum may be 
added to each dose. 

Vegetable remedies containing tannic acid, such as calumba, rhatany, 
pure tannic acid itself, and astringents in general, are with difficulty 
administered to small children, unless mixed with large quantities of 
syrup, and, on that account, should be seldom resorted to. In older 
children, they may be oftener employed. 

120. R. Aluminis, gr. vj 

Syrupi acaciae, f-^hj- M. 

A teaspoonful thrice daily. 

This will sometimes check the diarrhoea, which has been uninfluenced 
by any of the above remedies. 

Dr. Y. has often convinced himself of the utter inefficacy of all 
therapeutic remedies in the treatment of this disease when the child is 
not sustained on milk diet. 

The best prophylaxis consists in rendering the cow's milk given the 
child alkaline, by the addition of the following soda solution to each 
meal: 



DIARRHEAL DISORDERS. 115 

121. R. Sodii carbonatis, 3J 

Aquae, f-^vj. M. 

Several authors have very forcibly urged the importance of cold in 
infantile diarrhoea. Mr. E. Pocock, of London, invariably orders ice 
in large quantities, as well as frequent sponging with cold water, and 
he directs that all nourishment (unless the child be sucking) should be 
iced. 

Dr. McKenna, also of London, in cases of great exhaustion, em- 
ployed cold-water baths, stimulant ice injections, and iced drinks. 

Cold baths especially are called for where there are marked cerebral 
symptoms. Dr. C. G. Comegys, of Cincinnati, has especially urged 
this treatment on the American profession. He says its great value is 
in cases where an inflammatory process is set up — enterocolitis, in 
which the discharges • are more frequent, retaining, however, more or 
less the traits of the " loose bowels" so-called, with the addition of a 
high fever — 102.5° to 106°. The pulse is much more frequent — ISO- 
ISO ; the mouth is dry, the thirst intense ; eyes staring, contracted 
pupils ; insomnia, vomiting, rolling of the head, and distressing cries, 
due to hyperemia of the cerebral vessels and the unappeased thirst. 
The frequent vomiting and diarrhoea inhibit digestion or absorption of 
nutritious substances, and the brain is imperiled, for an effusion is im- 
pending, and general collapse. In this alarming condition the greatest 
relief may be found in immersions of the body in cool or even cold 
water, from twelve to fifteen minutes, every three hours, until the fierce 
symptoms are relieved, and relief will positively be obtained. It has 
now been a number of years since Dr. C. adopted this method of treat- 
ing enterocolitis, and he has not lost a patient. 

He claims that the immersion plan is much better than the wet pack, 
because the radiation of the febrile heat is more rapid and equable from 
the surface of the body. He has also used the pack about the chest 
and abdomen for many years in private and hospital practice, and he 
considers it not only more troublesome to apply, but of greatly inferior 
effect. Internally, Dr. C. uses small doses of mercurials and rhubarb. 

THEODORE TURK, M. D. 

In the Med. Cliir. Centralblatt, No. 1, 1873, this author says, in the 
more chronic cases a series of careful observations have shown him that 
roasted acorns, prepared as coffee, with a few beans of the real article, 



116 DISEASES OF CHILDREN. 

form the best dietetic, and at the same time medicinal remedy. Often, 
when nitrate of silver, tannin, Dover's powder, etc., have proven use- 
less, the simple acorn coffee (boiled, in cases of specially profuse diar- 
rhoea, with from one to three grains of tannin, and in meteorism or sick- 
ness, with the addition of a piece of orange-peel to the decoction,) has, 
from the first, lessened the stools and improved their quality, and very 
shortly restored the appetite and nutrition. At the same time the 
children become, not fat, but healthy. The acorn coffee is more effica- 
cious than alkalies, preparations of lime, tonics (Peruvian bark and ex- 
tract) and carminatives. Moreover, the children drink it readily, with- 
out becoming tired, and the painful, formal, and frequent administration 
of medicine is avoided. 

DR. BLACHE, PARIS. 

This author in the Journal de Therapeutique, May, 1878, gives the 
following as his treatment in all cases, modifying it according to circum- 
stances: 1. Reduction of the quantity of food given; suitable injec- 
tions, repeated according to need, and poultices on the belly. 2. The 
administration each morning, during three, four, or five consecutive 
days, of a small teaspoonful of equal parts of castor oil and syrup of 
gum arabic, simply emulsified by shaking the bottle at the time it is 
used. When the child is under six months old, 15 drops of castor oil 
are enough for a dose ; and if from six months to two years old, from 
f.Sss to f.oj are necessary. 

If after the second day the diarrhoea be less but has not entirely dis- 
appeared, no more of the medicine should be given than on the day be- 
fore. On the other hand, if the stools be particularly foetid and glairy, 
another dose must be given on the same evening, as well as on the 
next day. If the case be one of profuse liquid diarrhoea, recurring 
twelve, fifteen, or even more times, in the twenty-four hours, the mix- 
ture must be altered, doubling or trebling the dose of gum, and adding 
a little vinum opii, from one to three drops, at the most, according to 
age, in the four and twenty hours, and the medicine must be repeated 
every two or three hours. 

The object or effect of this castor oil treatment is to cleanse the mu- 
cous membranes, which it modifies, without, however, purging, in the 
general acceptation of the term. Injections are equally useful. First, 
a large injection of chamomile tea is given, followed in twenty minutes 



DIARRHEAL DISORDERS. 117 

by a small injection of starch. These are repeated whenever a series 
of four or five actions of the bowels occur in the space of from six to ten 
hours. In the latter case, bran or marsh-mallow is substituted for 
chamomile. As to the astringents, more especially bismuth, so often 
used in these cases, Dr. Blache distrusts them, as they may bring 
on convulsions, doubtless by preventing the cleansing of the mucous 
membrane. 

DR. JAMES L. TYSON, PHILADELPHIA. 

The treatment of this practitioner is by cold baths, chloral enemas 
sulfoxide of zinc. 

The cold bath is insisted upon at least three times a day, but not at 
a lower temperature than 80°-85° Fahr. 

The enema he uses is : 

122. R. Chlorali hydratis, ^ss 

Aquae amyli, t'-Sy- ^« 

For an enema. One to two and a half teaspoonfuls to be forcibly thrown 
into the bowels from a small glass syringe. 

In some cases where the discharges were lienteric and the tenesmus 
excessive, this spasmodic action of the sphincter and lower bowels could 
only be controlled by repeated resort to the remedy, two or three ap- 
plications being requisite before it could be retained, and then only by 
directing the nurse or mother to compress the glutsei muscles on either 
side, close over the anal orifice, for two or three minutes. When thus 
kept in immediate contact with the inflamed, sensitive, and irritable 
tissue, the benefits were prompt and enduring. Tenesmus, or choreal 
spasm of the bowel, was arrested, pain and inflammation were allayed, 
and the little sufferer would rest or sleep comfortably for several hours. 
A repetition of the enema was made once, sometimes twice, in the 
twenty-four hours, with increased comfort and alleviation of all the 
symptoms. 

The oxide of zinc is administered as follows : 

123. R. Zinci oxidi, £ss 

Pulv. acaciae, 

Sacchari albi, aa ," ij 

Lactopeptinae, 3J 

Aquam einnamomi, q. s. ad f.gj. M. 

A teaspoonful every five or six hours. 

This combination exerts a happy influence on the primse viae, enab- 



118 DISEASES OF CHILDREN. 

ling the child to digest its food more thoroughly, and controlling the 
number while it alters the character of the evacuations in a day or two. 
It is needless to add that strict attention to diet should be enforced. 



This author tells us that the treatment of diarrhoea must, in a great 
measure, depend upon its causation. Very careful attention must be 
paid to the diet. The age of the child and its constitution must be re- 
garded, and particular notice should be paid to the gradual or sudden 
nature of its illness. Before the appearance of teeth, milk in some 
form must be relied upon, and all farinaceous food must be forbidden ; 
a small quantity of lime water is a useful addition to the milk. Simple 
diarrhoea, arising from irritation of the lining membrane of the bowels, 
must not be too hastily checked, since by this means nature eliminates 
the offending matter ; but if the diarrhoea continues, it must be checked 
by such remedies as castor oil or rhubarb, soda and magnesia. In 
older children grey powder with Dover's powder will be useful, or the 
administration of a little bismuth. As a rule, it is a mistake to give 
astringents in the early stages of diarrhoea ; the best plan being first to 
eliminate the offending matters, and subsequently to check the diarrhoea, 
if it is excessive. If the child is strong, the motions containing blood 
or mucus, and there is no pain in the abdomen, a mixture of tincture 
of rhubarb, sulphate of magnesia and peppermint water may prove ser- 
viceable. If there be much exhaustion, a few drops of brandy may be 
given in weak milk or arrow-root. For the treatment of bilious 
diarrhoea, alkalies, especially soda, may be combined with one or two 
minims of tincture of opium; but this last drug must be administered 
with the greatest caution in the case of very young children. 

DR. EDWARD HENOCH, OF BERLIN. 

This author gives us some very explicit advice for the treatment of 
diarrhoea. He says that in the treatment of a recent catarrhal diarrhoea, 
we must first determine whether it was preceded by constipation and 
also whether an attack of indigestion was the exciting cause of the dis- 
ease. Under such circumstances it is best to begin with a mild purga- 
tive, a teaspoonful of castor oil, or a few doses of calomel (tV to J gr.), 
especially if tenesmus is present and the passages are small in quantity 
and mixed with bloody points or streaks. After the purgative has 



DIARRHEAL DISORDERS. 119 

operated, the diarrhoea not infrequently disappears in a few days. As 
almost all primary intestinal catarrhs of childhood have a dyspeptic 
origin, we may use purgatives at first in almost every fresh case, even 
if the causative indigestion and dyspepsia cannot be positively proven. 
But if profuse, thin evacuations have lasted for some days or exposure 
or the misuse of a purgative, such as tartar emetic, can be proven to be 
the cause, he would keep the child warm in bed, give only farinaceous 
food and prescribe 

124. R. Infus. ipecac, rad, f-SUJ 

Mucil. gum. arab, 

Syr. simpl, aa f. giiss 

Tinct opii, get. ij-iv. M. 

S. — Dessertspoonful every two hours. 

If the diarrhoea resists these remedies and lasts for a week or more, 
he uses subnitrate of bismuth in large doses. 

125. R . Bismuthi subnit, gr. ^— £ 

Pulv. gummosi, gr. j. M. 

S. — Give this powder every two hours. 

This should be continued for from ten to fourteen days to prevent a 
relapse. In very obstinate cases he adds the aqueous extract of opium, 
■fa to tV gr. to each powder. Some cases become chronic in spite of all 
these measures. He then uses 

126. R. Decoct, rad. Colombo, f. ^iij 

Syr. f. 5 v 

Tinct. opii, gtt. iv. M. 

S. — A dessertspoonful every two hours. 

Or, 

127. R . Decoct, cort. cascarillae, f. ^ iij 

Syr. f. J5 v 

Tinct. opii, gtt. iv. M. 

S. — Dessertspoonful every two hours. 

These remedies are very effective, though difficult of administration 
on account of their bitter taste. 

Tannic Acid may impair the already diminished appetite, but is 
sometimes very useful. 

128. R . Acid, tannici, gr. xv 

Tinct. nucis vom, gtt. xv 

Aq. destil., f.£ iij 

Syrup, f. 3 v. M. 

S. — Dessertspoonful every two hours. 



120 DISEASES OF CHILDREN. 

He has sometimes used the following with success in apparently hope- 
less cases, and has never observed any injurious toxic action. 

129. R . Plumbi acetici, gr. £ 

Pulv. gummosi, gr. j. M. 

S. — Give this powder three times a day. 

But all these remedies may prove useless or even act injuriously, by 
producing anorexia, nausea or vomiting. For such cases he resorts to 
the injection or pouring of medicinal fluids into the intestines, a plan 
which may produce surprising results if faithfully carried out. He 
employs an ordinary irrigator or glass funnel, to which a rubber tube, 
with an end piece of bone or ivory is attached. The end passed into 
the rectum, should be free in its cavity, so that the fluid can escape. 
The injections are best performed in the knee-elbow position, but it can 
also be done in right lateral decubitus. As a rule he employs a solu- 
tion of acetate of lead, more rarely, alum and tannin. This method 
requires persistent use, as a favorable effect cannot be expected in the 
first few days. Regulation of diet, without which recovery is impossi- 
ble, meets w T ith great obstacles in children. It should be confined to 
meat-broths, milk, red wine, soups, eggs, rice, farina, and finely 
chopped meat ; all articles which have a tendency to ferment — vegeta- 
bles, fresh and cooked fruit, leguminous articles, etc., must be pro- 
hibited. The only objection to raw scraped meat is that it may give 
rise to tape-worm. 



Prof. Rossbach, in Jena, has made a series of observations (Deutsch 
Med. Zeitung, 1884), and discovered that in all catarrhal conditions of 
the intestines, whether they co-existed with ulcerations or not, also in 
all inveterate chronic intestinal affections, and in those of the small in- 
testines as well as in those of the large bowels, provided they did not 
depend upon organic, incurable diseases, as cancer, etc., naplitalin w r as 
a specific, and invariably caused the disappearance of the malady. He 
never noticed any bad side or after-effect, and most of the naphtalin 
passed off again by the bowels, while a small percentage of it, changed 
to phenol, made its appearance in the urine. The usual dose for adults 
was from eight to ten grains daily. The remedy had also a very favor- 
able influence upon all cases of vesical catarrh, the purulent discharge 
at once ceasing, and he attributes its beneficial effect in such cases to 



DIARRHEAL DISORDERS. 121 

the changing of naphtalin to phenol in the urine — as phenol, especially 
in the nascent state, is a very powerful aseptic remedy, at once destroy- 
ing all micro-organisms with which it comes into contact. 

Patients generally do not object to the taste of naphtalin, if it is 
purified and obtained by sublimation ; as a corrigens for its odor, a few 
drops of bergamot oil can best be recommended. He found it especi- 
ally valuable in the diarrhoea of children. 

DR. H. C. SHUTTEE, OF MISSOURI. 

Prophylactic measures are of the first importance, for by a proper 
regimen and attention to ordinary hygienic conditions, the disease may 
be reduced to the minimum. After the disease is once established, di- 
etetic measures are of the greatest importance. A favorite prescription 
with this author is some good preparation of pepsin alternated with 
tannin. Aromatic sulphuric acid, combined, if there is any gastric 
irritability, with creasote or carbolic acid, is excellent. 

DR. J. LEWIS SMITH, OF NEW YORK. 

This author (Archives of Pediatrics, 1884), urges strongly the im- 
portance of not over- feeding infants in summer, since the surplus of 
food over and above that required for nourishment, will undergo fer- 
mentative changes and thus become a potent cause of summer diarrhoea. 
In conjunction with Dr. Chadbourne, of New York City, he has made 
some important experiments upon the amount of food required by young 
children, and as a result he concludes that under the age of two months 
the stomach is so small that it cannot receive more than one or one and 
a-half fluid ounces without distension ; at the age of six months, the in- 
fant can probably take and digest, without discomfort, three ounces, 
and in the last half of the first year, even four ounces. Infants nour- 
ished at the breast may be allowed to nurse every two hours, during 
the daytime, no matter what the age, after the second month ; but less 
frequently at night, for frequent nursing promotes the secretion of milk, 
and the milk is of better quality than when it is long retained in the 
breast. If, by the fifth or sixth month, mothers or wet-nurses find, as 
is frequently the case, that they do not have sufficient milk, other food 
should be given in addition, perhaps after every second nursing, or 
every fourth hour. By knowledge on the part of the mother and 
nurse of the dietetic needs of the infant, and by consequent judicious 
alimentation, and by measures also to procure the utmost purity of the 



122 DISEASES OF CHILDREN. 

air, there can be no doubt that summer diarrhoea can be, to a great ex- 
tent, prevented. 

Curative Treatment. — The indications for treatment are : 1st. To 
provide the best possible food. 2d. To procure pure air. 3d. To aid 
the digestive function of the infant. 4th. To employ such medicinal 
agents as can be safely given to check the diarrhoea. The infant with 
this disease is thirsty, and is therefore prone to take more nutriment 
than it requires for its sustenance. If nursing, it craves the breast ; or, 
if weaned, craves the bottle at short intervals to relieve the thirst. 
No more nutriment should be allowed than is required for nutrition, for 
the reason stated above, and the thirst may best be relieved by a little 
cold water, gum-water, or barley-water, to which a le,v drops of brandy 
or whisky have been added. 

When the child for some good reason cannot receive human milk, 
Dr. Smith gives the preference to pancreatized milk. Five grains of 
extractum pancreatis (Fairchild & Co's), and ten grains of sodium bi- 
carbonate, are added to one gill of warm water. This is mixed with 
one pint of warm milk, and the mixture, in some convenient vessel, is 
placed in water kept at a temperature of 100°F. for one hour, or less 
time if it begin to be bitter, when it is placed upon ice to prevent 
further digestion. With some specimens of milk, especially at a tem- 
perature of 115° or 120°F., a half hour, or even less, is sufficient. The 
artificial digestion is arrested either by boiling the peptonized milk, 
which destroys the ferment, or by reducing its temperature to near the 
freezing-point, which renders it latent and inactive but does not destroy 
it. 

Milk from healthy, properly-fed cows may be prepared without pep- 
tonizing so as to agree with many infants, except in the warmest 
weather, but is obviously less easily digested than peptonized milk. It 
should be diluted as follows, with water boiled so as to free it from 
germs: In the first week after birth, one-fourth milk, with the addition 
of a little sugar. The milk should be gradually increased so that it is 
one-third by the end of the fourth week ; one-half by the end of the 
third month; and two thirds to three-fourths by the end of the sixth 
month. After the sixth month it is still proper to add one-fourth water, 
but pure milk may be given. 

It is very important to determine when and how farinaceous food 
shall be given in this disease. It is well known that infants, under the 



DIARRHEAL DISORDERS. 123 

age of three months, digest starch with difficulty and only in small 
quantities, since the salivary and pancreatic glands, which secrete the 
ferments which digest starch, are almost rudimentary at that age. But 
the artificial digestion of starch is easily accomplished. Among the 
last labors of the renowned chemist, Baron Liebig, was the preparation 
of a food for infants, in which the starch is digested, transformed into 
grape-sugar, and thus infants at any age, who are fed with it, are re- 
lieved of the burden of digesting it. The Baron led the way, which 
has been so successfully followed since, in the artificial digestion of 
foods. A considerable part of the starch in wheat-flour is converted 
into grape-sugar by the prolonged action of heat. He frequently re- 
commends that from three to five pounds of wheat-flour be packed dry 
in a firm muslin bag, so as to form a ball, placed in water sufficient to 
cover it constantly, and kept over the fire three or four clays. During 
the nights the fire may go out for a few hours. At the expiration of 
this time, the external part, which is wet, being peeled off, the remainder 
resembles a lump of yellowish chalk. The flour grated from it gives a 
decided reaction of sugar by Fehling's test. Starch is also quickly 
transformed into glucose by the action of the diastase of malt, which 
indeed Liebig employed. If to a gruel of barley-flour, oatmeal, or 
other farinaceous substance, when hot, a little of a good preparation of 
extract of malt, as that prepared by Trommer & Co., at Fremont, Ohio, 
which acts promptly, or by Reed & Carnrick, be added, it becomes 
thinner from the conversion of the starch into sugar. Farinaceous sub- 
stances thus prepared may be used with peptonized or other milk. 

To select the best food for the infant is one of the most important 
duties of the physician. If called to an infant, unfortunately deprived 
of wholesome breast milk, and suffering in consequence from indigestion 
and diarrhoea, he would advise as follows: Use cow's milk of the best 
possible quality, and peptonized in the manner stated above, and pep- 
tonized in small quantity at a time, as one pint, or better, half a pint. 
This may be the sole food till the age of five or six months. Farinaceous 
food can be allowed in addition even to young infants, if a considerable 
part of its starch be converted into glucose. His preference as regards 
farinaceous food is for the wheat-flour prepared by long boiling. For 
infants under the age of six months, one tablespoonful of the flour thus 
prepared should be mixed with twelve tablespoonfuls of water, and 
heated. To one teacupful of this, one-half teaspoonful of the extract 



124 DISEASES OF CHILDREN. 

of malt (as Trommer's extract prepared for children) should be added. 
The diastase of the malt quickly converts a considerable part of the 
starch that has not already been converted by the boiling into glucose. 
The glucose renders it sweet and palatable, and a little salt should 
be added to it. It does not seem to mix well with peptonized milk, 
and can be given separately through a nursing-bottle. He usually 
makes it the vehicle for brandy or whisky, which infants with diarrhoea 
usually require. It is also a good vehicle for albumen. If the diges- 
tion of the infant be feeble, as in atrophic cases, and it seems to re- 
quire more nutriment, the white of the fresh egg mixed with the food 
aids in supplying the deficiency, and it is easily digested even by 
atrophic infants. 

Beef, mutton, or chicken-tea should not be employed, at least as it 
is ordinarily made, since it is too laxative. Occasionally for the older 
infants the expressed juice of beef, raw scraped beef, or beef-tea pre- 
pared by adding half a pound of lean beef finely minced to one pint of 
cold water, allow it to stand cold half an hour, and then warm it to a 
temperature not exceeding 110° for another half hour. By this pro- 
cess the albumen is preserved. Salt should be added to it, and he is 
in the habit of adding to it also about seven drops of dilute muriatic 
acid, to facilitate its digestion. It is chiefly for infants over the age of 
ten months that the meat-juices are proper. 

An infant weakened and wasted by the summer diarrhoea, removed 
to a cool locality in the country, should be warmly dressed, and kept 
indoors when the heavy night dew is falling. Patients sometimes be- 
come worse from injudicious exposure of this kind, the intestinal catarrh 
from which they are suffering being aggravated by taking cold, and 
perhaps rendered dysenteric. 

Sometimes parents, not noticing the immediate improvement which 
they had been led to expect, return to the city without giving the 
country a fair trial, and the life of the infant is then, as a rule, sacri- 
ficed. Returned to the foul air of the city while the weather is still 
warm, it sinks rapidly from an aggravation of the malady. Occasionally 
the change from one rural locality to another, like the change from one 
w r et-nurse to another, has a salutary effect. The infant, although it 
has recovered, should not be brought back while the weather is still 
warm. One attack of the disease does not diminish, but increases, the 
liability to a second seizure. 



DIARRHEAL DISORDERS. 125 



This author (Lancet, 1884), calls attention to a form of diarrhoea in 
which the main symptom is an irresistible impulse to defecation almost 
as soon as food is taken ; pain may or may not be present ; there are 
no symptoms of dyspepsia. The passages are usually semi-solid, not 
watery or slimy, and frequently contain undigested food ; usually a 
passage after each meal and one or two more in the twenty -four hours. 
The explanation given is that of increased peristalsis without increase 
of secretion. It is probably due to irritation of the vagus. The close 
connection of the nucleus of the vagus with that of the fifth nerve, sug- 
gests that probably dentition may sometimes be a reflex cause. As- 
tringents had always failed signally in the treatment, but remedies 
directed to the neurotic origin, such as opium and especially the bro- 
mides, had always given prompt relief. 

DR. GUAITA, OF ITALY. 

According to this writer (G-az. Degli Ospitali, 1884), the summer 
diarrhoea of children is due to a microbe, is a zymotic disease. Acting 
upon this supposition, the author used benzoate of soda with very good 
results. The following is the plan of treatment which was adopted: 
A moderate purge of calomel or jalap was first given, and then from 
one to one and a half drachms of the benzoate in three ounces of water, 
in divided doses, during twenty -four hours. The same quantity was 
given upon the second day, and upon the third a mild purge of mag- 
nesia or manna, after which the benzoate was resumed. Improvement 
invariably began after two days, the stools becoming less fetid, and the 
vomiting ceasing. During the treatment little food was given, but in 
its stead lemonade and generous wine. Milk and soup were entirely 
discarded, the former because it had been observed that its use, espe- 
cially in the form of cow's milk, was followed by fermentation, and 
consequently by an increase in the severity of the disease. When the 
patients were nursing children, they were allowed to take the breast 
only four times in the twenty-four hours. In addition to the benzoate 
of soda, other medication might be employed in all cases in which it 
would seem to be indicated. 

DR. J. V. SPRING, OF ARKANSAS. 

After decrying the use of opium in gastro-intestinal inflammation of 
infants and children, this author describes his treatment as follows 



126 DISEASES OF CHILDREN. 

(Mississippi Valley Medical Monthly, 1881). He has a tan bath 
prepared, by boiling red or black oak bark, until he gets the ooze as 
strong as it can be made in a short time. Then, while at a temperature 
of 75° or 80° F. he places the child in the bath, having enough liquid 
in the bath to come up to the shoulders when the patient is in a sitting 
posture, and keeps him there until all restlessness passes away and he 
becomes quiet, which, in some cases may take ten or fifteen minutes. 
Then rub him well with a coarse towel and anoint the body thoroughly 
from head to foot with cod-liver oil, place large cloths saturated with the 
bark ooze over the stomach and bowels, wrap him in flannel and put him 
to bed, withdrawing all other treatment, and keeping water and every 
kind of nourishment out of the stomach. Repeat the bath and cod-liver 
oil every three or four hours, until all bad symptoms give way. He 
then gives 

130. R. Bismuth, subnit, 

Cretse preparatse, aa 3il 

Syr. bals. tolu, f. % j 

Aquae menth. pip, f.5* v - ^/L- 

S. — Teaspoonful every three hours. 

When quinine is indicated, he gives each dose in a teaspoonful of the 
above mixture. 

DR. A. M. CAMPBELL, OF GEORGIA. 

The history of a number of cases of choleraic diarrhoea in infants, 
treated by Koumiss is given by Dr. A. M. Campbell, in the Obstetri- 
cal Journal, 1880. In administering Koumiss, the gas should first be 
expelled, by pouring the contents from one bottle to another. Begin 
with small doses, gradually increasing the amount ; and, when the 
stomach will bear it, barley water may be used to quench thirst. Be- 
fore returning to a full milk diet, it is better, for a few days, to use one 
of the prepared foods. 

DR. WILLIAM B. ATKINSON, OF PHILADELPHIA. 

In the Medical and /Surgical Reporter, 1880, this author thus sums 
up the subject. When the case is seen early, and the symptoms lead 
to the belief that the attack is the result of the presence of indigestible 
or undigested matter in the bowels, (for either, being a foreign body, 
acts as an irritant,) a small dose of castor oil, of calcined magnesia, 



DIARRHEAL DISORDERS. 127 

or of the spiced syrup of rhubarb may be given, with the view of ex- 
pelling such matters. It is rarely necessary to continue, or even to 
repeat these remedies. With a proper regulation of the diet, of the 
hygienic conditions, etc., in very many cases, the attack ceases, and 
no further medication is requisite ; or a few closes of aromatic powder, 
v-x grs. every two hours, will complete the cure. Should the loose- 
ness of the bowels continue, it becomes necessary to employ an astrin- 
gent ; an alkali if there is much acidity ; and some form of narcotic to 
relieve pain. 

Of astringents, catechu, kino, and logwood are most frequently em- 
ployed. 

As antacids, we have bicarbonate of soda, or potassa, lime water, 
chalk mixture, and bismuth. 

Perhaps no formula can be employed with better result, in the great 
majority of cases, than one combining the subnitrate of bismuth with the 
compound powder of ipecacuanha. 

For a child, one year old, we may give — 

131. R. Pulv. ipecac comp., grs. vj-ix 

Bismuthi subnitrat., 3 j. M. 

Ft. chartulse, No. xij. 

Dose. — One every two to four hours, accoiding to the urgency of the 
symptoms. 

In cases where for any reason a mixture is preferable, we may use — 

132. R. Bismuthi subnitrat., 3\1 

Tincturse opii camph., f-3i v 

Syrupi simplicis, 

Mucilag. acaciae, aa f.giss. M. 

Dose . — Teaspoonful, as before. 

It must not be forgotten that blackening of the stools will result from 
the use of bismuth, and this fact should be mentioned to the mother, as 
in some instances this condition has created great alarm, as portending 
a grave complication. 

When acidity is a prominent symptom, we may employ with the bis. 
muth the compound powder of chalk, with opium, in doses of one to 
three grains for a child of one year. 

In all cases where opium is employed it is important to watch its 
effects, and where drowsiness or cerebral symptoms occur, it should at 
once be omitted. Should a child die comatose, it is difficult to dissuade 



128 DISEASES OF CHILDREN. 

its attendants from the belief that it has died from the effects of opium. 
It seems that the whole benefit obtained from the use of this drug is 
the so-called " putting the bowels in splints." It checks the peristaltic 
action, quiets the restlessness due to the pain, and thus allows nature 
to return to her proper condition. 

In this connection, we must insist upon the great importance of rest 
in the horizontal position. This is constantly forgotten ; the child is 
carried about over the shoulder of the attendant, jolted on the knee, or 
in a rough rocker, thus keeping the bowels in a perpetual turmoil. We 
see the good effects of rest by the almost invariable improvement after 
a good nap. Therefore, never disturb a child from its sleep, even 
though the hour for giving the medicine may be at hand. 

In persistent cases we may give : 

133. R . Tr. catechu, 

Tr. kramerise, 

Tr.kiuo, aa f. ^ij 

Tr. opii camph., f. 3 1V 

Spt. ammonias arc-mat., f. gij 

Syrup, simp., 

Aq. cinnamomi, aa f. Jfiss. M. 

Dose. — Dessertspoonful every two to four hours, according to age and 
urgency of symptoms. 

Where, for any reason, the alcohol may be objectionable, we may 
employ astringent infusions of catechu in doses of one or more tea- 
spoonfuls, repeated as above. 

When the discharges are quite offensive, the addition of a small 
quantity of the solution of chlorinated soda, two to five drops in each 
dose of the astringent mixture, will correct this trouble and aid in the 
cure. We prefer this to the use of carbolic acid, which rarely fails to 
prove so offensive to the child that it obstinately refuses to take the 
mixture. 

An old formula, and one which we have seen to be of great service 
both in chronic and other forms of diarrhoea, is the mixture of nitrous 
acid with opium and camphor water. 

134. H. Acidi nitrosi, tt\,xxv 

Tr. opii, n\xv 

Aq. camphorse, 

Syr. simp., aa f. ^iss. M. 

Dose. — Teaspoonful every three or four hours. 
In a number of instances this has given most excellent and speedy 



DIARRHEAL DISORDERS. 129 

results. Where opium may be contraindicated, we may substitute ex- 
tract of hyoscyamus, say half a grain in each dose. 

We always prefer to give the above doses in two or three times the 
quantity of solution of acacia, or rice or barley water. 

In cases of great restlessness employ the bromide of potassium or 
sodium, or chloral, or the bromide and chloral may be usefully com- 
bined, as mentioned previously. Rest is imperatively demanded for 
the cure of this condition. 

When the skin is hot and dry, tepid sponging is of great value, and 
by itself often gives so much comfort that the little patient sinks into a 
refreshing slumber, perhaps the first it may have had for several days. 

In cases where much flatulence is present, perhaps no remedies are 
more useful than chloroform and turpentine. The former may be em- 
ployed in a formula like the following : 

135. R. Chloroformi, gtt. xxx 

Tr. opii campli., 

Tr. cardam. comp., aa f. ^ij 

Mucilag. acaciae, 
Syrupi simplicis, 

Aq. menthae viridis, aa f. % j. M. 

Dose. — Teaspoonful every hour, or even every half hour, or oftener, as 
occasion demands. 

The turpentine may be given as follows : 

136. R . 01. terebinthinae, f. 3 j 

Tr. opii camph,, 

Tr. cardam. comp., aa f-SU 

Magnesiae calcinata, gr. x 

Mucilag. acaciae, 

Syrupi simplicis, aa f. ^iss. M. 

Dose. — Teaspoonful every two or three hours. 

In all cases it is well to commence early with some tonic, and we 
have found the best and most useful to be the solution of the per-nitrate 
of iron with calumbae, as mentioned in the previous paper. 

During the treatment the physician must constantly remember that 
the child requires food as well as medicine. Give milk, with a due pro- 
portion of lime water, with stimulants added as required, beef essence, 
beef or mutton tea, chicken, or rice water, also cold water freely. 
Nothing is gained by cruelly keeping the child suffering with thirst. 



This author states in a monograph (1879), that he has employed ice- 



130 DISEASES OF CHILDREN. 

water injections for more than a year, in those forms of diarrhoea, es- 
pecially of children, which depend on some alteration of the colon. 
After each stool he injects from 200 to 300 ccm. of cold water, which 
is caused to run out again by slight pressure on the abdomen ; then he 
injects 50 ccm. to be retained. The effect of this treatment is surpris- 
ingly good, and the mothers readily give their consent to it. 

DR. A. JACOBI, OF NEW YORK. 

In the American Journal of Obstetrics, 1879, Dr. Jacobi very 
fully covers the ground of treatment in diarrhoea and dysentery of 
infants. So far as nutriment is concerned, the amount of food should 
not be larger than we have reason to expect can be easily digested. 
At all events, either lengthen the intervals between the meals or reduce 
the quantity of fooc\ given at one time, or both. When diarrhoea 
makes its appearance in infants who have been weaned, it is desirable 
to return them to the breast. Those who never had breast-milk may 
be given the breast if they can be induced to take it, but only rarely 
will this be found possible. Whenever a child at the breast is taken 
with diarrhoea, the passages from the bowels should be studied as to 
their contents. If a certain amount of curd is found in them, the least 
that is to be done is to mix the breast-milk with barley- water. This 
may be done in such a manner that, each time before nursing, one or 
two teaspoonfuls of barley-water is given the child, so that the farina, 
ceous food and the breast-milk will mix in the stomach. Or, it may be 
found advisable to alternate breast-milk and barley-water. In bad 
cases, particularly when the milk is found to be white and heavy and 
contains a great deal of casein, it will be found necessary to deprive the 
child altogether of its usual food. In such cases, the child will do 
better on barley-water alone (this to be continued for one or two days) 
than to expose it to the injury which will certainly follow the continua- 
tion of the casein food. 

When diarrhoea occurs in children who have been fed alone upon 
cow's milk, unmixed or mixed, it is necessary to reduce the quantity of 
cow's milk in the mixture. As a rule, we have to remember that 
cow's milk alone is apt to produce diarrhoea, and it should be consid- 
ered as a maxim that, whenever diarrhoea makes its appearance, the 
amount of cow's milk given to the child should be reduced. When a 
mere reduction of the quantity does not suffice, it is very much better 
to deprive the child of milk food altogether. Not infrequently the re- 



DIARRHCEAL DISORDERS. 131 

moval of milk from the bill of fare is the only thing which will restore 
the child to health. It is possible that a mixture, such as recommended 
by Dr. Rudisch, of which I have spoken before, will be found diges- 
tible, even in such cases. My experience, however, is not sufficient to 
decide that point. In many cases as a dietetic measure, it will be 
found advisable to add one or two tablespoonfuls of lime-water to each 
bottle of food with which the child is supplied. 

In those cases in which barley-water does not seem to suffice as a 
nutriment, or where it would be dangerous to allow children to lose 
strength, a mixture which I have used to great advantage is the follow- 
ing : Mix the white of one egg with four or six ounces of barley-water, 
and add a small quantity of table salt and sugar, just sufficient to make 
the mixture palatable. The child can take this either in large or small 
quantities, according to the cases. 

In such cases in which the stomach is irritable and vomiting has oc- 
curred, it is now and then better to give a small quantity, even one or 
two teaspoonfuls, and repeat the dose every ten, fifteen, or twenty 
minutes, than to give large quantities at longer intervals. 

In those in which the strength of the child has suffered greatly, it is 
necessary to add brandy to the mixture in such quantity that the child 
will take from one drachm to one ounce (grammes 4.0 to 30.0) more 
or less, in the course of twenty-four hours. 

In those extreme cases in which the intestinal catarrh is complicated 
with gastric catarrh, where the passages are numerous and copious, and 
vomiting constant, where both medicines and food are rejected, there is 
frequently but one way to save the patients, and that is to deprive them 
absolutely of everything in the form of either drink or food or medicine. 
It is true that such babies will suffer greatly from thirst for an hour or 
two, but it is a fact that, after two or three hours, these children will 
look better than before the abstemious treatment was commenced. Not 
infrequently four or five hours of total abstinence will suffice to quiet the 
stomach and diminish both the secretion and the peristaltic movement of 
the intestinal tract. In some cases six or eight hours of complete 
abstinence will be required ; or such children may be starved for even 
twelve or sixteen hours, with final good results. The first meals after- 
wards must be quite small, and they will be retained, and, as a rule, 
such children will subsequently do well. 

1 need not here say that, in addition to the dietetics for the digestive 
organs, it is necessary to supply the patient with as much cool, fresh 



132 DISEASES OF CHILDREN. 

air as possible. The worst out-door air, when cooler, is better than 
close in-door air. The undeveloped condition of the nerve-centre in 
the normal infant, the relaxation of the inhibitory nerves by heat, the 
absence of radiation from the surface, the lacking stimulus — during hot 
weather — of the cutaneous sensitive nerves, the diminished metamor- 
phosis of tissue, the diminution of the powers of digestion, not only by 
shortening nutrition, but by directly lowering the secreting powers of 
digestive glands in the stomach and intestines, are just as many factors 
in the production of the very worst forms of infant diarrhoea. I have 
kept very baa, desperate cases out all night upon the bluifs over the 
East river. The windows must not be closed. If possible, the children 
should be sent immediately to the country and into the mountain air. 

The second indication consists in the removal of undigested masses 
retained in the intestinal tract. Not only in cases in which the diarrhoea 
has resulted from previous errors in diet of the child, but also in those 
cases dependent upon sudden changes of temperature and exposure, it 
iu desirable to empty the intestinal tract of its ballast. For that pur- 
pose castor oil, calcined magnesia, or calomel may be used. So far as 
the latter is concerned, the discrepancy of opinion with regard to its 
efficiency will probably be found to depend upon the variation in the 
size of the doses recommended by different authors. When a purga- 
tive effect is desired it should not be given in small doses, and, accord- 
ing to age, from two to six (0.1-0.4) grains should be administered. 

3. Nothing should be given that contains salts in any sort of concen- 
tration. Thus, beef tea should be avoided. It has come very largely 
into use in practice among children, both in this country and in Great 
Britain. In Germany, too, it has found very many advocates, and 
am~r»g some who have abandoned the obsolete notion that when pre- 
pared in the customary way it contains a large proportion of protein in 
its composition. It must be remembered that this form of meat extract 
contains a very large amount of salts, and that the direct effect of these 
upon the intestinal canal may be productive of very unpleasant conse- 
quences. It is a mistake to give it when the intestines are irritated or 
very susceptible of irritation, for the reason that diarrhoea is apt to 
directly follow its use. Nevertheless, I have often seen beef tea given 
under these very circumstances, for no other object than the vain one of 
furnishing the child w T ith a great amount of nourishing food. This is 
very commonly done during the obstinate and exhausting diarrhoea of 
summer. If the people insist upon giving it, and there is no special 



DIARRHCEAL DISORDERS. 133 

contra-indication to its use in a given case, it should be administered 
only in connection with some well-cooked farinaceous vehicle, and the 
best of all for this purpose is barley-water ; or it may be mixed with 
beaten white of egg, but no more chloride of sodium should be added — 
for the main danger in beef tea is the concentrated form in which its 
salts are given. 

4. Everything should be avoided that increases peristaltic motion. 
Thus, carbonic acid and ice internally. 

5. Avoid whatever threatens to increase the amount of acid in the 
stomach and intestinal tract. There is so much acid in the normal, and 
still more in the abnormal stomach and intestinal tract, that it is abso- 
lutely necessary to neutralize it. For that purpose any alkali, perhaps, 
will suffice, but it is safer to resort to preparations of calcium than of 
sodium or magnesium. Soda and magnesia, when introduced into the 
stomach and duodenum, will find a number of acids and form laxative salts. 

• Frequently I use carbonate of lime ; not infrequently phosphate of lime. 
Both of these will act as antacids, but the latter preparation is to be 
preferred in those cases in which free phosphoric acid is deemed of im- 
portance for the purpose of facilitating pancreatic digestion. 

So far as lime-water is concerned, its administration, certainly, is cor- 
rect chemically. But we should not place too much reliance upon this 
popular remedy. We should not forget that it contains about one part 
of lime to eight hundred of water, and that it is necessary to swallow 
at least two ounces of the fluid in order to obtain a single grain of 
lime. 

A further indication is, the necessity of destroying ferments. For 
that purpose most metallic preparations will do fair service. One of 
these, that has been extensively used, is calomel, and now in small 
doses frequently repeated — to, J, or J a grain (0'1-0'15-0*03) every 
two or three hours. As to its effects as an anti-fermentative, there can 
be no doubt. It is very uncertain, however, as to how it produces this 
effect. It is possible that it acts by a portion of the drug being 
changed very slowly to the bichloride of mercury, which is known to 
be a very powerful agent in the prevention of fermentation. It is cer- 
tain that one portion, at least, of the mercury is used to bind sulphide 
of hydrogen, which often acts in a poisonous manner. Infants will 
bear calomel very well, perhaps for the reason that elimination is so 
much more rapid in them than in adults. 

Nitrate of silver, when given for the same purpose, should be 



134 DISEASES OF CHILrREN. 

largely diluted. From 4V to i 1 ^ of a grain (0* 0015-0* 004) dissolved 
in a teaspoonful or tablespoonful of water, may be given every two or 
three hours, and not infrequently with fair result. At all events, it 
does not answer to use a concentrated solution. Whenever it is con- 
centrated, it acts more as a caustic than as an astringent. This remark 
is especially important with regard to injections of nitrate of silver 
into the rectum, where it is apt to do as much harm as good. Even a 
mild solution — one or two grains to the ounce of water (1:500 or 250) 
— when injected into the rectum is apt to give rise to tenesmus and 
soreness about the anus ; whenever it is to be given in that way, the 
solution should be mild and largely diluted, or the anus and its neigh- 
borhood should be washed with salt water before the injection is admin- 
istered. 

Bismuth acts very favorably. Moderate cases of diarrhoea will 
usually show its effect very soon. Doses of from J to 2 or 3 grains 
(0.03 — 0.20,) given every two or three hours, will act very favorably in- 
deed. In those cases in which the diarrhoea has lasted for a long time, 
and a large surface of the intestinal tract is certainly implicated, the 
doses of bismuth should be large in order to be certain of immediate 
contact of the drug with the sore surface. 

A final indication is the depression of the hyperesthesia of the gen- 
eral system and of the intestinal tract in particular. The effect of 
opium is very probably an anatomical one, and brought about in such a 
manner that a combination takes place with the nerve plasma. As this 
is so much softer and succulent in the child than in the adult, the effect 
is so much stronger. There have been authors who condemned the use 
of opium altogether, -^hich certainly is incorrect. The doses should be 
small, and they may be repeated frequently. Administered in this 
manner, opium can be used with perfect safety both internally and in 
an enema. For, when the doses are small, it is possible to stop before 
an overdose has been given. One of the rules for giving opium is this 
— the child should not be waked up for the purpose of taking the medi- 
cine. Opium does not always act as a depressant, but sometimes as an 
excitant. This difference in the effects produced by the drug is well 
known. Very small doses will act as an excitant, while relatively large 
ones will act as a depressant. The exciting doses, will, when accumu- 
lated, also show their constipating effect, and whenever there is fear of 
collapse, it is safer to give -sks of a grain (0.0003) every half-hour or 
hour, than to administer -h of a grain (0.0012) every two hours. 



DIARRHEAL DISORDERS. 135 

Alcohol. — Small and frequent doses will certainly stimulate the ner- 
vous system, digestion, and circulation, and they also stimulate the skin 
and increase perspiration. Alcohol, given in this manner, certainly 
arrests fermentation. Moreover, it takes the place of food, and will 
act favorably as food when no solid carbo-hydrates are tolerated by the 
intestinal tract. As it is absorbed in the stomach, so does it protect 
the intestinal tract. It has been found that, when only small quantities 
of milk and pure alcohol and water are given as food, the body in- 
creases in weight. But it is absolutely necessary that the alcohol or 
the alcoholic preparation should be pure. Fusel oil will dilate blood- 
vessels, produce and increase congestion, and prove dangerous. Where 
no good brandy or whiskey can be procured, it is better to use alcohol 
in substance diluted with water. 

Finally, it is necessary to reduce the amount of secretion taking 
place from the surface of the intestinal tract. For that purpose astrin- 
gents may be used, such as alum, lead, tannic acid, pernitrate of iron, 
and, what has already been spoken of, nitrate of silver. In all those 
cases in which the stomach participates in the process to any considera- 
ble extent, almost any astringent will prove ineffective. Neither alum 
nor lead nor tannic acid may do otherwise than irritate the stomach, 
and it will be necessary to depend altogether upon nitrate of silver, or 
better upon bismuth, for the purpose of meeting two indications. To 
fulfil several indications at the same time, it is often good practice to 
combine remedies. 

The main indications are to neutralize acids, to reduce nervous irrita- 
bility, to arrest secretion, and to change the condition of the surface of 
the catarrhal mucous membrane. 

For that purpose, in the generality of cases, I combine bismuth, 
opium, and chalk according to the following formula : 

137. R. Bismuth subnit., gr. i. 

Cretae praeparat, grs. ij. 

Pulv. doveri, gr. \. 

This combination is suitable for a baby ten or twelve months of age, 
and the dose can be repeated every two hours. In all those cases in 
which acid is very abundant, it is necessary to increase the doses of an- 
tacids without necessarily giving large doses of opium. 

Whenever it is necessary to stimulate, and alcohol alone does not 
meet, the requirements, resort may be had to hot bathing. This is es- 



136 DISEASES OF CHILDREN. 

pecially serviceable in those cases in which the surface is cool and the 
temperature of the body, measured in the rectum, is pretty high. A 
hot bath in which the child may be kept for two or three minutes will 
restore some warmth to the surface, dilate blood-vessels, reduce tempera- 
ture, and act as a nervous stimulant. To relieve intestinal pain, plain 
warm fomentations ; to relieve heat, cold applications are sufficient. 

Camphor stimulates the heart and reduces temperature, and may 
be used internally or subcutaneously, according to the necessities 
in the case. For subcutaneous injections camphor may be dissolved in 
either oil or alcohol. The effect derived from camphor as a stimulant 
is not permanent, but still very much more permanent and steady than 
that produced by carbonate of ammonia. 

The dose may be from \ to J a grain (0.015-0.03) every hour or 
two, when only a moderate stimulation is required. In urgent cases it 
may be given in doses of from five to ten grains (0.3 — 0.6) in the course 
of an hour, and usually the effect will be favorable. 

It is, however, only in cases in which real collapse is present that 
doses of five or ten grains will be required, and it may then be admin- 
istered dissolved in alcohol, and with or without musk. 

There is no remedy that will act more favorably in conditions of great 
debility and collapse — collapse with or without spasmodic symptoms — 
than musk. It is true it is scarce, very frequently spurious, is expen- 
sive, and must be given in larger doses than usually recommended. 
But in cases of collapse, doses of five to ten grains (0.3-0.6) should 
be given at once, and should be repeated every half-hour or hour. 
More than two or three such doses will not be required to yield a re- 
sult. 

A writer in the Revue de Therapeutique Med. Chirurg., 1881, re- 
marks that the treatment of intestinal catarrh in infants should be per- 
severed in until a complete cure be obtained ; the gastro- intestinal 
functions should be completely re-established before ceasing treatment. 
The proper therapeutic measures consist in the employment of bismuth 
and laudanum, and without this last medicament it is very difficult to 
have complete cure, in infantile diarrhoea. The following potion may 
be given, a teaspoonful at a time, in the course of twenty-four hours : 

138. R. Bismuttri subnit., 3ij 

TiEct. opii, TT\,ij 

Mucilag. acacise, %iv. M. 



ENTERO-COLITIS. 137 

An enema, of starch should be given morning and evening. The little 
patient should be kept in bed. This treatment should be continued for 
eight days, then the doses should be diminished, but the progress of the 
case should receive careful attention. 

DR. JOHN M. KEATING, OF PHILADELPHIA. 

This author {Medical and Surgical Reporter, 1883,) would treat 
an entero-colitis as he would a common coryza, only bearing in mind 
that the intestinal canal in children is much more important than the 
nasal organs. He gives alkalies internally, as sodium-bicarbonate or 
ammonium bicarbonate, if the child is very weak, with a small dose of 
ipecac, as a stimulant to the mucous membrane, or bromide of potassium 
or ammonium and minute doses of paregoric if there is much paroxysmal 
pain. In some cases he gives the following : 



139. 


B. 


Magnesiae sulph., 


gr. iv 






Yin. ipecac, 


gtt. xvj 






Syr. rhei aromat., 4 


gtt. xl 






Spts. ammoniae aromat., 


gtt. xvj 






Tinct. opii camph., 


gtt. xvj 






Syr. lactucarii, 


f-.^ij 






Aq. menth. virid., 


qs ad f. |j. 



M. 

S. — One teaspoonful every hour to a child aged six months. 

But should there be much pain or mucus in the stools, the treatment 
will consist of castor oil. When a mother says that her child has fre- 
quent, slimy, curd-like passages, and there is pain, straining and the oc- 
casional appearance of blood, he gives 

140. Be . 01. ricini, f.giss 

Glycerinae, f. 3 ij 

Pulv. acaciae, 5>iss 

Aq. cinnamomi, f.gj&f # 3ij. M. 

Ft. emulsio, 

S. — Tablespoonful at a dose. 

The emulsion should be given every two hours, until the stools begin 
to change color — probably four doses will be required ; then the child 
should be placed upon bismuth and acacia in powder, until the irritability 
of the bowel has entirely subsided. 

In convalescence, after a severe protracted attack he gives: 

141. R. Ferri et quiniae citrat., gr. iv 

Tinct. nucis vomicae, gtt. j 

Syrupi, 

Aquae, aa q. s. ad f.gj. M. 

S. — Teaspoonful three times a day for a child six months old. 



138 DISEASES OF CHILDREN. 

If the bowels have been very loose and the vomiting excessive, 
he gives: 

142. R. Acidi sulphuric! aromat., gtt. viii 

Ext. rhei fluidi, gtt. iv 

Spt. vini gallici, f. 3 ij 

Syr. acaciae, 

Aq. menthae, aa q.s. ft. f.gj. M. 

S . — Teaspoonful every two hours to a child six months old ; give slowly 
with a little water. 

Should the passages not be very frequent, but the vomiting be the 
most important symptom, he gives : 

143. R . Hydrarg. chlor. mite, gr. § 

Ipecac (pulv. :), gr. £ 

Pulv. acaciae, 

Sacchari lactis, aa gr. ij. M. 

Ft. chart. No. IV. S. — One every hour, placed dry upon the tongue. 

This is to be followed by a teaspoonful of castor oil and a drop of 
essence of peppermint, poured into a tea-cup of hot water and skimmed 
off the top, the object being to thoroughly subdivide the oil before its 
administration. The oil may be preceded by quarter-grain doses of 
hydrarg. cum creta. Should there be marked suppression of urine, and 
as soon as the vomiting has been controlled, he gives at intervals of two 
or three hours, a tablespoonful or more of toast-water with ten to fifteen 
drops of sweet spirits of nitre and, if the child will stand the extra 
stimulation, it can be made more diuretic by the addition of fifteen to 
twenty drops of good gin. 

DR. W. W. PEXNELL, OF OHIO. 

This practitioner does not believe that paregoric is contra-indicated 
in cases where brain symptoms are present. If the case is seen early, 
or if there is reason to suspect the presence of any irritating substance 
in the bowels, he gives castor oil or glycerine. He uses the latter 
where there is much acidity of the gastro-intestinal tract, or if thrush is 
present. After cleansing the bowels he orders : 

144. R. Tinct. opii camph., f-^UJ 

Bismuthi subnit., 

Pepsinae sacch., aa gj 

Aquae destil., f.giiss. M. 

S. — One teaspoonful every three or four hours to a child one year old. 
The bottle should be well shaken. 



DIARRHEAL DISORDERS. 139 

DR. E. H. BARTLEY, OF NEW YORK, 

Recommends the following formulae, in the iV. Y. Medical Journal, 
1884, for irritative diarrhoea : 

145. R. Ol.ricini, f.$iv 

Bismuth, subnitratis, 3U 

Magnes. carbonatis, 3i 

Sacchari, 3U 

01. anisi vel ol. menth. pip., ^ivj. M. 

Sig. — gj. for a child of six months to one year. 

Or we may use : 

146. R. Vin. pepsinas, f. % jss 

Bismuth, subnit., 3; 3 j 

Glycerini, 3 iv. M. 

Sig. — 3J- a t a dose. 

Dr. Mecray, of Cape May, New Jersey, highly recommends the 
following : 



M. 



DR. R. L. MOORE, OF MINNESOTA, 

Highly recommends the following: 

148. R. Hydrarg. cum creta., gr. x 

Sacch. alb., 3J. M. 

Triturate well and add : 

German tinct. bell., gtts. xv 

Aquae, f . ^ iij . M. 

S. — Teaspoonful every hour. 

DR. JAMES CRAIG, OF JERSEY CITY. 

This author considers (Archives of Pediatrics, 1884), that the in- 
dications are to prevent nausea and vomiting, support the strength, and 
check diarrhoea. If nursing, no change in diet is made, but care 
should be taken not to nurse the child too often or too much at a time. 
If bottle-fed, the milk is stopped, and stale bread soaked in hot water, 
with a little sugar and brandy added, or Robinson's prepared barley or 
arrowroot, made with water and given in small quantities, answer a 



147. 


R . 01. ricini, 


f.3iv 




Tr. opii, 


gtt. iv 




Pulv. acacia, 






Sacch. alb., 


q. s. 




Aq. menth. pip., 


adf.Jij. 


Sig.- 


—Dessertspoonful every three hours. 





140 DISEASES OP CHILDREN. 

good purpose. Milk is also prohibited where the child is weaned, but 
is gradually resumed as it improves. Where the child is weak, one 
teaspoonful of brandy to six or seven of water, a teaspoonful of which 
is occasionally given. Where a more powerful stimulant is required, 
carbonate of ammonia, in one or two grain doses, mixed in syrup of 
acacia, is used according to the age of the child. For the gastric and 
intestinal derangement his favorite prescription is : 

149. K. Liq. acidi carbolici, 5 per ct., f.3J 

Bismuthi subcarb., 

Pepsini sacch., aa £j 

Aquae cinnamomi, ,^iij 

Syr. aurantii cort., f. 3 ij. M. 

Sig. — A teaspoonful every two or three hours until relieved. 

He applies over the abdomen a spice plaster, composed of the follow- 
ing: powdered cinnamon, cloves, nutmeg, ginger, allspice, of each 5\j« 
Honey and glycerine, of each, 5vj. White of one egg. Mix and 
spread on cheese cloth or fine mosquito netting. It may remain on 
over the region of the stomach and bowels for hours and days without 
blistering — it merely reddens the skin and is an excellent counter- 
irritant. A bandage should be applied over it to keep it in place. 
Change of air frequently brings about convalescence in a short time. 
When that cannot be had, the next best thing is to take the child out daily, 
for an hour or two at a time, early in the morning and late in the after- 
noon. While in the house, the child should be kept in a well ventilated 
room free from draughts. 

NOTES ON REMEDIES. 

Acacia in solution is both soothing and nourishing. * 

Acid Carbolic is recommended in the British MedicalJournal, 1883, in half minim 

doses, combined with bismuth and aromatic confection in the vomiting 

and diarrhoea of children. 

Alkalies are highly extolled by Dr. J. P. Oliver (Boston Medical and Surgical 
Journal, July, 1875,) in diarrhceal diseases of infants. The alkali should 
always be combined with an aromatic. 

150. R . Potassii bicarbonatis, 9 j 

Aquse cinnamomi, f. \ ij . M. 

A teaspoonful or two to a child of eighteen months, in milk or barley 
water. 

This prescription, with a few grains of pepsin if there is atony of di- 
gestion, and sometimes a little stimulant, will cure most cases. 
Argenti Nitras. In acute catarrhal diarrhoea, summer diarrhoea, and the diar- 



DIARRHCEAL DISORDERS. 141 

rhoea of dentition, this salt is used by Dr. Mullbr and others, in doses 
of gr. 2i~8- He says the special indications for it are : (1) Croupous 
deposits on the mouth and fauces ; (2) peculiar redness and smoothness 
of the tongue ; (3) irrepressible thirst. In obstinate cases of the chronic 
form Trousseau recommends as an enema, 

151. R. Argenti nitratis, gr.j 

Aquae, f-§v. M. 

For an enema. A portion to be used twice daily. 

Arsenicum. Dr. Ringer, advocates gtt. j-ij of the liquor arsenicalis in cases of 
children from eight to twelve years, where the motions are semi-solid, 
with lumps of half-digested food. 

Bael. This East Indian astringent is growing in popularity in Great Britain. 
Dr. R. P. Ritchie writes of it to the Medical Times and Gazette, 1879, 
that in the chronic diarrhoeas of children, especially those of a dysen- 
teiic character, it seems especially valuable. 

BismutM Salicylas has been found very useful by Dr. Kilner (St. Thomas 
Hospital Reports, 1879,) when the diarrhoea seems to be entirely depen- 
dent on 'the heat of the weather. He uses good-sized doses — two or 
three grains for a child under six months, and from three to five or 
more, when above that age. 

BismutM Suonitras is commonly used in the more chronic forms. It is also of 
value in the acute forms where there are sour-smelling and offensive 
stools. Large doses are necessary. 

Calcium Salicylas. See BismutM Salicylas (above). The indications and doses 
are the same. 

Camphor, in acute diarrhoea of infants, may be given as a few drops of the tinc- 
ture on sugar or in milk, every two or three hours. 

Catechu is a favorite astringent with some. 

152. R. Tinct. catechu, 

Tinct. kino, aa H\,x 
Syrupi, it^xv 

Aquae cinnamomi, f«3y- M. 

For one dose every three hours. 

Carbolicum Acidum. In chronic diarrhoea, especially of the feculent variety, Dr. 
Ellis has found the greatest benefit from the use of carbolic acid in- 
ternally in doses of gr. £-§ in well-sweetened water, for children about 
two years old. 

Ceanothus Americanus or Jersey Tea is highly recommended by Dr. S. P. Hub- 
bard, of Virginia (Med. and durg. Reporter, 1880). A weak decoction, 
made in an earthen vessel, sweetened with loaf sugar or honey and used 
as a drink, he has found an excellent remedy in teething diarrhoea. 

Chalk. Mistura cretse, with or without opium, is highly useful in the diarrhoea 
of children. 

* Chamomile is highly recommended by Dr. Christopher Elliott, (Practi- 






142 DISEASES OF CHILDREN. 

tioner, 1882,) in infantile diarrhoea connected with dentition, and in 
"which the stools an; many in number, green in color, or are slimy and 
streaked with blood and accompanied by pain and cramp. He gives 
gSS-j of the infusion to a child under one year, and double the quantity 
to a child over that age, giving it three times a day or oftener according 
to the severity of the attack. 

Ergota and ergotin are recommended in some cases, especially where the diarrhoea 
is without febrile action, and rather a wasting mucous discharge. 

Ferri Tinctura CJiloridi. In diarrhoea from the use of impure water or unripe 
fruit, Dr. Lawson has found the most, effective treatment gtt. ij-vj of 
this tincture in an appropriate vehicle, several times a day. 

Oallicum Acidum, gr. j-v, dissolved in hot water, well sweetened and then 
allowed to cool, is very serviceable in chronic diarrhoea. 

lltrmatoxylon is a favorite astringent with many. 

Ilydrargyri Chloridum Mite. Many practitioners commence the treatment of 
acute infantile diarrhoeas with small doses of calomel with soda, chalk 
or other alkali, and perhaps a few grains of rhubarb. Quite large doses 
of calomel, gr. x-xxx, are undoubtedly valuable in desperate cases. In 
rickety, scrofulous or tuberculous children, Ellis advises that no form 
of mercury be given. 

Bydragyri Chloridum Corrosivum. Dr. Ringer long since recommended minute 
doses of corrosive sublimate for the infantile diarrhoea with very slimy 
stools, especially if mixed with blood and accompanied by pain or 
straining. Lately in this dysenteric and other chronic forms it has 
been urged by Dr. RtJDOLPH RAVENBTJRG, of Washington, D. C, gr. 
ss-j to water Oj, of which a teaspoonful may be taken at a dose. 

Ipecacuanha, in small and repeated doses, is often most useful in the acuter 
forms. 

Krameria is a pleasant and efficient astringent. 

Nux Vomica. In lienteric diarrhoea, where the food passes through the bowels 
almost unchanged, Dr. MtJLLBR regards nux vomica as a specific. 
The child should have salt-water baths and its diet be carefully regu- 
lated. 

Opium may be given by enema, with starch, where there is marked griping and 
tenesmus ; or by the mouth, as 

J 53. R. Tincture opii, ntj-ij 

Potassii citratis, gr. iij-vj 

Syrupi aurantii, Jjss 

Aqua! cinnamomi, i'. ,^ ij. M. 

This at a dose every three or four hours. 

Pepsin, and the various forms of it, are indispensable in many cases. • 
Rheum. When at the outset of an attack it is desirable to cleanse the bowels 

of offending substances, rhubarb is one of the most appropriate means. 

The powder or spiced syrup may bo used ; or the alkaline tincture of 



DIAKRIICEAL DISORDERS. 143 

the German Pharmacopoeia, which is especially praised in infantile 
diseases by some writers. It is prepared as follows : 

154. I*. Rhei, 100 parts. 

Boracis, 

Potassii carbonatis, aa 10 " 

To these add 

Aquae bullientis, 850 " 

Set aside for fifteen minutes ; then add 

Alcohol is, 100 " 

Aquas cinnamomi, 140 " 

Ricini Oleum. It is excellent practice in acute cases to commence with a mild 
emulsion of castor oil. 

Salicin is recommended by Dr. Lawhon in summer diarrhoea induced by the 
direct action of heat on the nervous system ; and by Dr. Aitken in 
those from both this and other causes which deteriorate the tone of the 
system. 

Salicylicum Acidum. Dr. J. M. Keating, of Philadelphia, has recently em- 
ployed with much satisfaction this drug in the acid diarrhoeas of chil- 
dren. His formula is 

155. U. Acidi salicylici, gr. ss 

Spts. amnion, aromat., gtt. v 

Aq. month, piper., q. s. M. 

For one dose for a child a year old. 

Sodii Benzoas. Dr. E. Ullmann, of Vienna, (Allg. Med. Zeit., Sept. Gth, 1870,) 
states that he had repeatedly proved the value of this substance in the 
Bummer diarrhoeas of young children. The dose is 3ss-ij, in solution, 
divided during the day. 

Tannicum Acidum is a useful astringent. Dr. Ellis prescribes : 

156. ]£. Acidi tannici, gr. v 

Acidi nitiiei diluti, rr^vj 

[nfusi gentians© comp., f-.^U- M. 

Every three or four hours, to a child of ten years. 

Valeriana. Dr. L. A. Davioson, of West Virginia, (3/edical and Surgical Re- 
2~>orter, Nov., 1877,) commends the following as a most efficacious pre- 
scription in the ordinary diarrhoeas of children : 

157. 1£. Extracti valeriani iluidi, f.gss 

I'uiv. calumbse, BiH v 

Syrupi rhei, kgss. M. 

Zinci Oxidumha* been highly extolled by Drs. Huakenridge, of Edinburgh ; 
Tyson, of Philadelphia; J. C. Kknton, of Glasgow, and others; but 



144 DISEASES OF CHILDREN. 

Dr. Ellis finds it disappointing. Its especial value is in nervous, lien- 
teric cases. A child of six months should have gr. ij every six hours, 
in powder or mucilage. No sugar should he used with it. If so em- 
ployed, it will he found a remedy of real and great power, capahle of 
restoring even severe dysenteric cases, almost in extremis. 



DIPHTHERIA. 

THE PROPHYLACTIC TREATMENT. 

It is the opinion of Prof. E. N. Chapman, M. D., of Brooklyn, that 
a decided stimulant, especially alcohol, taken regularly, will protect 
persons from the diphtheritic poison. He prescribes for those in health 
who are exposed to it, the following: 

158. R . Quinoidine, 

Cinchonise sulphatis, aa gr. xxv 

Acidi sulphurici aromatici, f. 3 ij 

Spiritus frumenti, f. .1 viij. M. 

Fifteen drops to a tahle spoonful, according to age, four or five times a day. 

The German Prof. Klebs, from experiments to ascertain what drugs 
have a destructive influence on the diphtheritic process, believes that 
he has shown that the most potent in this direction is the benzoate of 
soda, and is inclined to think that the administration of this substance 
will strongly tend to prevent the establishment of the disease. He also 
uses it when the attack begins, 5j-ij> to a child of five years. 

In all cases of illness, when diphtheria is prevalent, it is expedient 
to look into the throat, as, occasionally, when there is not even ground 
of suspicion, the characteristic spot or layer of moldiness, like an 
irregular patch of white kid, will be discerned. Now is the time when 
one single painting with a strong solution of nitrate of silver may 
effectually destroy the parasite and rescue the patient. Twenty -four 
hours later, and the attempt will be vain. 

In a paper read at the Medical Society of Victoria, and published in 
the Australian Medical Journal, 1880, " On the Free Use of Salt 
as a Prophylactic Against Diphtheria" Dr. Day stated that, having 
for many years past looked upon diphtheria in its early stage as a 
purely local affection, characterized by a marked tendency to take on 
putrefactive decomposition, he has trusted most to the free and constant 



DIPHTHERIA. 145 

application of antiseptics ; and when their employment has been adopted 
from the first, and has been combined with judicious alimentation, he 
has seldom seen blood poisoning ensue. In consequence of the great 
power which salt possesses in preventing the putrefactive decomposition 
of meat and other organic matter, Dr. Day has often prescribed for 
diphtheritic patients living far away from medical aid the frequent use 
of a gargle composed of a tablespoonful or more of salt, dissolved in 
a tumbler of water ; giving children who cannot gargle a teaspoonful 
or two to drink occasionally. During the prevalence of diphtheria, he 
recommends its use instead of sugar in the food of children, adults 
using the gargle as a prophylactic, three or four times a day. 

M. HAGER, OF GERMANY. 

In the Pharm. Centralblatt, 1882, M. Hager recommends lozenges 
composed after the following formula, to persons who are exposed 
to the contagion of diphtheria : 



M. 



159. R. Ceraealb., 
Colophon, 


3v 

3iss 


Melt together, and then add 




B . Tolutan. balsam, 
Pulv. aromat., 
Sach alb., 
Ac. benzoic., 


5 iiss 
3 iss 

3 i ss iiss. 


Reduce to fine powder and aromatize with 




160. R. 01. cinnamomi, 
Creasoti, 


TTIX 

3J. 



M. 



M. 

After the mass has cooled, divide into 100 pastilles. One of these 
lozenges should be very slowly masticated four or five times daily. 

GENERAL TREATMENT. 

PROF. J. LEWIS SMITH, M. D., NEW YORK. 

The internal treatment of this author is as follows, for a child of five 
years : 

161. R. Quinige sulphatis, 3 SS 

Elixir taraxaci comp., t'«3\J* -M-* 

A teaspoonful every two to four hours. 

162. R. Tincturse ferri chloridi, f.^ij 

Potassii chloratis, 3ij 

Syrupi simplicis, f. § iv. M. 

To be given hourly, between the previous mixture. 

10 



146 DISEASES OF CHILDREN. 

The tonic effect of the iron is not impaired by the chlorate of potas- 
sium, which is added to the mixture, on account of its local action on 
the inflamed surface. 

The citrate of iron and ammonia, alone or in combination with car- 
bonate of ammonia, may be given in 2-grain doses, dissolved in simple 
syrup, in place of the above mixture, when the inflammation of the 
fauces has considerably abated, or is moderate. If the patient im- 
prove, and the disease begins to abate, the intervals between the doses 
may be lengthened, but not discontinued. 

Local Treatment. — Forcible removal of the pseudo-membrane, irri- 
tating applications, the use of a sponge or other rough instrument, for 
making the applications, should be avoided as likely to do harm. The 
applications should be made either with a large camel's-hair pencil, or 
better, for most of the mixtures employed, with the atomizer. The 
hand atomizer, which is cheap and of simple construction, while it 
carries a heavy spray from the curved tube, which is introduced over 
the tongue, is very useful ; but the constant spray of the steam atom- 
izer is more effectual, and is preferable in severe cases. 

The following mixtures he is in the habit of using with the atomizer : 

163. R. Acidi salicylici, ^ss 

Glycerinae, f. ^ ij 

Aquse calcis, f-o vii J' M. 

164. R . Acidi carbolici, gtt. xxxij 

Glycerinse, I'.gij 

Aquae calcis, f. §vj. M. 

165. R . Acidi carbolici, gtt. xxxij 

Potassii chloratis, 3"J 

Glycerinse, 1'. % iij 

Aquse, f. % v. M. 

In many cases of diphtheritic inflammation of the fauces the spray 
suffices for local treatment, but the following mixture, applied by a 
large camel's-hair pencil, is also very effectual, immediately converting 
the pseudo-membrane into an inert mass, and putting a stop to all 
movements of the bacteria which swarm in it, as Dr. S. has observed 
under the microscope : 

166. R. Acidi carbolici, gtt. viij 

Liquoris ferri subsulphatis, f. ^ ij— iij 

Glycerinse, f.gj. M. 



DIPHTHERIA. 147 

This may be used two or three times daily, between the spraying, or 
oftener without the spraying. It is not irritating (such an effect 
would condemn it,) but it is dreaded by most children on account of 
the unpleasant "puckering" which it produces. 

If there is discharge from the nostrils indicating diphtheritic inflam- 
mation of the Schneiderian membrane, a little of the same mixture 
diluted with an equal quantity of warm water, is injected into each 
nostril every three to six hours. To do this, the child is placed upon 
its back, with the head thrown backward and the eyes covered with a 
towel to prevent the liquid from entering them. A small glass ear or 
nostril syringe, with a knob or button at the end of the nozzle, is the 
best form of instrument for these injections. 

One-third to one-half of a teaspoonful of the diluted mixture is a 
sufficient quantity to employ for each nostril. This application, prop- 
erly made, prevents decomposition, removes the offensive odor, and 
that which is of the greatest importance, prevents blood-poisoning. 

In three or four days, if the case progress favorably, these remedies 
are employed less frequently, but they are continued until not only 
the pseudo-membrane has disappeared, but the inflammation also has in 
great part abated. When the inflammation has begun to abate, and 
there is no re-appearance of the exudation, a gargle or drink of chlorate 
of potash is given. 

167. R. Sodii bisulphitis, 3j-ij 

Tincturse aurantii, f. 3 ij 

Aquae, f.3 x. M. 

One teaspoonful every two hours. Sometimes, in place of water a bitter 
infusion, like that of quassia, has been employed. 

The sulphites have not been found so valuable in this disease as was 
expected at their introduction. 

THOMAS R. DRYSDALE, M. D., PHILADELPHIA. 

This physician, after a wide experience in all the forms of diphtheria, 
is persuaded that the most valuable of all remedies is chlorate of 
potash, properly and efficiently administered. (Medical and Surgical 
Reporter, March, 1877.) He attributes its failures to the timidity 
with which it has been given. The formula he is in the habit of 
using is : 

168. R • Pulv. potassii chloratis, 3 ij 

Syrupi limonis, f. %j 

Aquse, f. 'Jiij. M. 



148 DISEASES OF CHILDREN. 

To a child under two years old, a teaspoonful ; from two to ten years old, 
a dessertspoonful ; and over this age a tablespoonful, which is also the 
dose commenced with in adults ; the dose being repeated every three 
hours, or oftener, according to the severity of the case. 

All local treatment, except by the solution itself, is unnecessary, for 
that it has a solvent action on the membrane, has been proved by 
experiment ; and the parts involved are so frequently bathed by swal- 
lowing it, that a true and free topical application is made every time 
it is administered. Taking advantage of this local action, the physi- 
cian should direct the nares to be injected with it when they are 
affected ; and in cases of croup, particularly after tracheotomy, apply 
it by means of the atomizer. 

Another advantage is, that other remedies may be used in connec- 
tion with it. For instance, when there is much spasm of the larynx, 
emetics may be given, and the chlorate used after them ; or, when the 
case is decidedly asthenic, iron and quinine, stimulants and nourishment, 
may be administered at the same time. 

This treatment has proved so successful, that when called to an ordi- 
nary case of diphtheria, before it has reached the larynx, or traveled 
upward toward the brain, producing convulsions, Dr. D. feels but little 
apprehension ; for, in a large practice of many years, but few cases 
have been met with which have resisted it. 

Dr. W. W. Carpenter asserts (in the South. Med. Rec, May, 
1879,) that chlorate of potash cannot be borne in sufficient quantity to 
cure an asthenic case of diphtheria, without causing a dangerous, if not 
fatal, depression of the heart. If combined with quinine or any of its 
alkaloids, to steady the heart's action, it can be safely borne in larger 
doses. In union with tinct. ferri mur. and quinia, we not only have a 
much more effective remedy, but a far safer one ; or it may be com- 
bined with sulphurous acid, as : 

169. H. Acidi sulphurosi, f-3 v j 

Glycerinae, f. % iv 

Sat. sol. potassii chloratis, ad f. ^viij. M. 

From one-half to two teaspoonfuls every half hour, according to age. 

Dr. James Tyson (in the Philadephia Medical Times, February 
15th, 1879,) speaks strongly in favor of Dr. Billington's treatment 
of diphtheria. This is the frequently-repeated small dose of tinct. ferri 
chloridi, and sol. potassii chloratis, alternately, every half hour, fol- 



DIPHTHERIA. 149 

lowing each, for two or three minutes, with a spray, from a hand atom- 
izer, of liq. calcis and carbolic acid. The formulae are : 

170. R . Tinct. ferri chloridi, f. 3 j-iss 

Glycerinae, 

Aquae, aa f.gj. M. 

171. R. Potassii chloratis, 5 ss ~j 

Glycerins?., f-S ss 

Liquoris calcis, f.giss. M. 

172. R. Acidi carbolici, tt\,xv 

Liquoris calcis, £§ V J- ^« 

For spray. 

DR. ROBERT BELL, GLASGOW, SCOTLAND. 

173. R . Acidi carbolici, f. % ij 

Acidi sulphurosi, f. gvj 

Tincturae ferri chloridi, 

Glycerinae, aa f.Jj. M. 

Apply to the throat with a large camel's-hair pencil, or by means of the 
spray apparatus, every two hours. 

174. R . Potassii chloratis, % iij 

Acidi sulphurosi, f. ^iijss 

Tincturae ferri chloridi, f. 3iij 

Glycerinae, f. £j 

Aquam, ad f. ^vj. M. 

A dessertspoonful every two hours. 

With this medication must be combined free stimulation and plenty 
of nourishment, in the shape of soups, jellies, and milk, from the very 
outset of the disease. 

DR. CARLO PAVESI, ITALY. 

This writer in the (Annali di Medicina, August, 1876,) gives a 
formula which he recommends in the treatment of diphtheria. It is 
founded on the antizymotic properties of chloral, salicylic acid, and the 
sulphites. It is as follows : 

175. R. Chloral hydratis, 

Acidi salicylici, 

Glycerinae, 

Sodii sulphitis, aa 3 iij 

Alcoholis, f. 3 ij 

Aquae, f. 'gvij. M. 

The whole is put into a strong glass vessel, which is closed, and ex- 
posed to a heat of 100° to 120° Fahr. for a few minutes, until the 



150 DISEASES OF CHILDREN. 

sulphite, salicylic acid, and chloral are completely dissolved. A homo- 
geneous solution is produced, which is filtered through bibulous paper, 
and preserved in a well-closed vessel. It is an oily, limpid, colorless 
liquid, having the odor of its constituent parts. It is insoluble with 
water. On the application of proper tests, the chloral, salicylic acid, 
sulphite of soda, and glycerine are found to be unchanged. 

Used both internally and externally, it is an energetic antiseptic, 
antifermentative, disinfectant, haemostatic, and preservative, as well as 
a destroyer of parasitic organisms. Dr. Pavesi says that it may be 
used as an antiseptic, and also as a sedative, in a large number of dis- 
eases. 

THOMAS HILLIER, M. D. F. R. C. P., ETC., LONDON. 

176. R . Hydrargyri chloridi mitis, gr. rij-vj 

Pulveris ipecacuanhse compositi, gr. vj. M. 

For six powders ; one every two or three hours for a child. 

Calomel is now almost discarded in the treatment of diphtheria. 
Our author is not prepared to give it up. In some of his worst cases, 
in which recovery occurred, this drug was the remedy. It is not to be 
used indiscriminately in all cases. It should be limited to children 
with moderate constitutions, and to cases in which the exudation is 
firm and thick, or causing laryngeal obstruction with sthenic symptoms. 
It is to be continued until the bowels are relaxed with greenish stools. 
At the same time, abundant fluid nourishment, and sometimes wine, is 
to be given. 

DR. H. V. SWERINGEN, FORT WAYNE, INDIANA. 

This observer believes that prompt cinchonism, followed by an 
alterative tonic, is the most proper and successful treatment for diph- 
theria. The line of treatment he pursued was as follows, for a child 
of six years old : 

177. R . Quinine sulphatis, gr. xxxij 

Acidi tannici, gr. x 

Syrupi simplicis, f. ^ j 

Olei menthae piperitse, gtt. iij. M. 

A teaspoonful every three hours until cinchonism is induced. 

After which (or it may be administered alternately with the above) 
the following is given : 



DIPHTHERIA. 15V 

178. R . Potassii iodidi, gr. xxxij 

Potassii bromidi, 3^ 

Syrupi simplicis, 

Tincturse cinchonse compositse, aa f-BJ. M. 

Make a solution. A teaspoonful every three hours. 

Alum and ipecac, as emetics, are useful when the exudation shows a 
disposition to extend to the larynx, or when there is much difficulty of 
breathing, from the tumefaction of the fauces, or from the accumula- 
tion of the pseudo-membranous deposits. 

DR. P. H. KRETSCHMAR, NEW YORK, 

Also strongly recommends cinchonism which he produces in children 
by the frequent use of the following ointment. (Hospital Gazette, 
1879.) 

179. R . Quinise sulphatis, 

Chloroformi, 

Balsami Peruvian!, aa 5 SS 

Adipis, 5 V J- M- 

For frequent inunction. 

DR. E. WISS, PRUSSIA, 

Also holds that quinine is the most potent drug to prevent the infection 
and destroy its activity. ( Wiener Med. Zeitung, No. 35, 1879.) Its 
action is increased by muriate of ammonia, which also acts beneficially 
on the catarrhal affection, With these iron is needed as a tonic. 
Hence Dr. Wiss' treatment is : 

180. R . Quinise sulphatis, gr. v-x 

Ammon. muriatis, ^iss 

Acidi muriatici, gtt. iij 

Syr. cort. aurant., 

Aquae destillatse, aa f. ^ iij. M. 

Dose, a teaspoonful or dessertspoonful for a child. 

As soon as the fever disappears he gives from five to ten drops of the 
tincture of the chloride of iron three times daily, in a wineglass of 
sweetened water. This practice he has pursued for thirteen years with 
most satisfactory success. 

DR. F. PEYRE PORCHER, SOUTH CAROLINA. 

181. R . Potassii chloratis, z j-ij 

Quinise sulphatis, $j 

Tinct. ferri chloridi, f. zjj 

Sodii hyposulphitis, z, j 

Aquae, f-S vi J- M. 

A teaspoonful to a dessertspoonful to persons exposed to diphtheria. 



Y 52 DISEASES OF CHILDREN. 

THOMAS HAWKES TANNER, M. D., F. L. S., ETC., LONDON. 

182. R. Quiniae sulphatis, gr. xxiv 

Acidi muriatici diluti, f-3lJ 

Tincturae ferri chloridi, f-3 H J 

Infusi calumbse, f-^vj. M, 

A tablespoonful, in water, thrice daily. 

This preparation is also recommended by Dr. Aitken for the treat- 
ment of diphtheria. 

Dr. C. S. Kilner says of iron, (Lancet, May, 1879,) that it is one 
of the best remedies in the disease. His treatment is to give the 
tincture of the chloride in large doses, internally, with chlorate of 
potash, and to swab the throat with: 

183. R . Acidi carbolici, 3 j 

Acidi sulphurosi, 3 iij 

Tinct. ferri chloridi, 

Glycerinae, aa f. !§ ss. M. 

Use locally to the throat. 

Stimulants and concentrated food from the outset. 

DR. T. M. LOWNDS, 

Writes to the Lancet (March 22d, 1879,) that for eleven years he has 
pursued the following treatment "with almost unbroken success :" 

184. R . Tinct. ferri perchloridi, f. % iij— iv 

Liquoris amnion, acetat., f. gjssnjj 

Potassii chloratis, 3J~J SS 

Aquam, ad f.gviij. M. 

The dose and frequency is modified according to age and severity of the 

disease ; in the worst cases a tablespoonful every hour, during the first 

day or days of treatment . 

He never interferes with the sloughing exudation in any way, only 
prescribing a gargle or wash containing half a grain of permanganate 
of potash in an ounce of distilled water, to be used frequently. This 
may be applied with a sponge or a brush, or inhaled as atomized vapor. 
He always tries to get one evacuation daily from the bowels, and sup- 
ports the powers of life by wine, soup, milk, etc., as each case seems 
to demand. Lastly, he insists on perfect ventilation of the bedroom by 
a window opened at the top. 

DR. B. RHETT, CHARLESTON, S. C. 

Upon seeing a case of diphtheria, this writer ( Charleston Medical 



DIPHTHERIA. 153 

Journal and Review, October, 1874; January, 1876,) at once gives 
a moderate mercurial purgative (hydrargyri chloridi mitis, gr. x.), on 
the importance of which he lays especial stress. Compare Dr. Hil- 
lier's remarks, above.) Tinctura ferri chloridi is then administered 
in suitable doses, and the throat is swabbed, gargled, or atomized with 
the following: 

185. B • Acidi muriatici, 

Acidi carbolici, aa Tt^xx 

Glycerinse, 3j 

Aquae, % vij. M. 

Use frequently. 

DR. ARMAND SEMPLE, OP LONDON. 

This author says that in the mild cases where the fauces only are 
affected, some local alterative should be employed, such as a strong 
solution of iron, but the constitutional treatment should never be ne- 
glected, because, even in slight attacks the constitutional symptoms are 
often serious. Iron and quinine should, therefore, be given, and wine 
or brandy, and strong beef-tea be also administered. Where the dis- 
ease attacks the larynx or trachea, the danger is multiplied a hundred- 
fold, and there is little chance for the patient, except in tracheotomy, 
by which the false membrane is removed. 

DR. EDWARD HENOCH, OF BERLIN. 

The views of this great authority are not very encouraging, for he 
repeats now what he said in 1874, namely, that in his experience, all 
remedies hitherto recommended, and he has tried almost all, with the 
exception of sulphur preparations, are entirely useless in severe cases 
of the disease, and these alone should be considered, since the mild 
cases recover spontaneously. He therefore limits himself to describing 
what he considers the most rational treatment, though he does not 
ascribe to it any specific action on the disease. Locally he uses gar- 
gles alone, or in small children, injections of the pharyngeal and nasal 
cavities with a solution of the chlorate of potash (10:500), alumen 
aceticum (25:500) carbolic acid (J per cent.) or equal parts of lime- 
water and distilled water. These remedies are employed most satis- 
factorily with a spray apparatus, as it can readily be forced between 
the teeth if the children resist. The object of this method is to remove 
decomposed masses as thoroughly as possible, to abolish the foe tor and 



154 DISEASES OF CHILDREN. 

to gradually loosen and dissolve firmly adherent exudations. For this 
reason he recommends the method suggested by Rigauer, of pouring 
four or five teaspoonfuls of cool water into the nose daily. He does 
not approve of penciling the affected surfaces with anything, as this 
only tends to excite the patient and, if done with force, may injure the 
mucous membrane. Such injuries must be avoided at any cost, on 
account of the almost unavoidable diphtheritic infection of all lesions of 
the mucous membrane. If the pharynx shows marked inflammatory 
redness and swelling, he applies an ice-bag to the throat and allows 
small pieces of ice to be frequently swallowed. Internally he recom- 
mends from the beginning, decoct, chinee (5 or 10:120) with aq. 
chlori. (10.0-15.0), in addition to nutritious diet (milk, broths, wine,) 
though this is often rendered impossible by the complete anorexia of 
many children. If no food will be taken, he resorts to nutritious ene- 
mata (meat solution, peptone, bouillon with egg, and wine.) He 
strongly warns against all methods which increase the tendency to col- 
lapse already present, especially large doses of chlorate of potash 
(small doses are harmless, but useless), which may, also give rise to 
dangerous intoxication and hemoglobinuria ; also large doses of qui- 
nine and salicylate of soda. Subsulphite of soda and inhalations of 
bromine have proved absolutely useless in his hands, as also has car- 
bolic acid internally and subcutaneously along the hyoid bone. He 
considers that we are equally powerless against diphtheritic collapse. 
In diphtheritic croup, he considers tracheotomy the sole measure from 
which we can expect any results, and he therefore advises its perfor- 
mance in all cases that are not moribund, or do not present severe 
symptoms of infection. 

It is of great importance not to perform the operation too late — after 
cyanosis, coolness of the extremities, and extreme orthopncea are pres- 
ent. It is advisable to operate on the appearance of the local signs of 
stenosis (continuous stridor in breathing, croupy cough, retraction of 
the lower part of the neck and the lower ribs). There is nothing to 
be lost by the operation, and everything to be gained. Even the pres- 
ence of pneumonia is not a contraindication. If the progress is favora- 
ble the canula may be removed, as a rule, on the sixth day after the 
operation. There may be considerable swelling of the mucous mem- 
brane which interferes with the removal of the canula, and under such 
circumstances there is always danger that a canula, which has been in 
the trachea for an unusually long time, may even cause ulceration, and 



DIPHTHERIA. 155 

finally give rise to polypoid proliferation. If this has occurred, the 
canula may not be removed, and the child must retain it for a very 
long time, until we succeed in removing the proliferation of the mucous 
membrane, and thus the danger of stenosis. Children upon whom 
tracheotomy has been performed, exhibit a special tendency to infection 
with scarlet fever. For diphtheritic paralysis Dr. Henoch recommends 
strychnia, subcutaneously, conbined with electricity. 

DR. J. N. COONS, OF MISSOURI. 

In the Medical and Surgical Reporter, 1884, this practitioner says 
that, given, a typical case of diphtheria of average malignity, in a 
child of eight or ten years of age, at an early stage of the disease — 
for then only is treatment of most avail — he would give, if the nervous 
chill has not passed, a teaspoonful of tinct. opii camph. to calm the 
nervous shock and quiet the aching limbs, after which he would clear 
the alimentary canal by a mild laxative, and at once give the following: 

186. R . Potassii chlordi (not cliloratis), 5 j 

Tinct. ferri chloridi, f-SU 

Syrupi scillse, f. % ss 

Syrupi simplicis, q. s. ad. f. ^ij. 

Misce. Sig. — One teaspoonful in a little syrup or water ever three hours ; 
to be continued throughout the disease, but at lengthened intervals, 
after all diphtheritic membrane shall have disappeared. 

With each dose of this alterative syrup he would give (according to 
frequency and hardness of pulse) from two to six drops of tinct. veratri 
viridis, till the pulse has been reduced to normal frequency and soft- 
ness, and then in lessened doses every six or eight hours, till cessation 
of all tendency to febrile excitation. 

Should an expectorant seem called for, he would direct : 

187. R . Tinct. sanguinariae canad, 

Tinct. ipecacuanhas, aa f. ^ss 

Tinct. opii camphoratae, f-S ss 

Syrup, tolutani, q. s. ad. f. 3 ij. 

Misce. — Teaspoonful as needed to loosen or quiet cough. 

From the first, food of some kind, preferably milk, soup, or other 
liquid or soft animal food, should be given at least as often as every 
three hours — say after each dose of medicine. Fruits, most vegetables, 
and acid syrups, are forbidden. As the vital powers weaken, cream, 
toddy, egg-nog, and occasional two-grain doses of quinine or salicine 
(the last preferably in capsule, to avoid faucial irritation) serve to 



156 DISEASES OF CHILDREN. 

bridge over the period of weakness, whilst possibly neutralizing the 
poison of the disease. 

Local Treatment. — Believing that the systemic infection largely 
springs from the constant inhalation and ingestion of the putrid pro- 
ducts of the local disease, coupled with the retention of effete matters 
produced by the irritative fever, he considers the local treatment quite 
as important as the systemic. 

He adds to hot water as much acetic acid as may be borne without 
irritation of the external surface (from 1-8 to 1-16 part), trusting 
that the inhalation of the vapors ever rising from the hot fomenting 
cloths will stimulate secretion and prevent deposit, if the vapor do not 
also redissolve membrane already formed in the fauces and air passages. 
The fomentation may be by flannel cloths or sacks of linseed meal 
reaching across the front of the neck from ear to ear, and kept fre- 
quently wetted in the hot diluted acetic acid (or vinegar in its ab- 
sence), and well covered with dry flannels to preserve the heat. 
Should the skin become irritated, the proportion of acetic acid must be 
lessened, or it must be omitted altogether from the fomenting liquid, 
lest we have a raw surface, forming a new nidus for the further exten- 
sion of the disease. For direct application of diseased fauces, nares, 
etc., he has found nothing so good as a saturated solution of chemically 
pure acetate of lead, to which may be added, when necessary (which 
is rare), a non-irritant antiseptic. This solution may be best applied 
in spray by means of an atomizer, but a gargle is of service, and the 
following powder dusted upon the parts will materially assist in causing 
the removal of any diphtheritic deposit formed in the fauces : 

188. R. Plunibi acetatis (C. P.) pulv., 

Pulv. gum. acaciae, aa 3j. 

Misce. Sig. — A small quantity to be blown upon the diseased parts two 
or three times a day. This may be done through a roll of letter sheet. 

When the larynx becomes involved, the inhalation of hot steam from 
a saturated solution of acetate of lead in dilute acetic acid furnishes 
probably as hopeful treatment as any with which we are acquainted. 

Summing up. — Relieve nervous shock, clear the alimentary canal, 
give veratrum viride till its constitutional effect is felt in a softening 
and slowing of the pulse, give the iron and chloride of potassa altera- 
tive steadily throughout the disease, adding an expectorant when 
needed; and most important, foment assiduously for the first few days, 



DIPHTHERIA. 157 

applying the acetate of lead freely and often to the diseased fauces. 
Lastly, forget not to feed liberally throughout the disease, and to stim- 
ulate and support freely by alcoholics and tonics, as the exigencies of 
the case call for, in the wane of the disease. 



Dr. A. Worthington was led to use cold water in diphtheria, be- 
cause he had successfully used it for twenty-seven years in all forms of 
scarlatina, and he says that he has not been disappointed. A cold wet 
cloth, large enough to cover the entire body, is wrapped around the 
patient, and it is covered with dry flannel ; it is changed every half 
hour for a fresh one. In the Canada Lancet for June, 1883, he thus 
concludes his article : 

1. The treatment of diphtheria must be begun with the invasion of 
the disease to secure any' safety to the patient — not a moment's time 
should be lost. 

2. The cold water application should be made on the first appear- 
ance of a rise in temperature, and its continuance governed by the ten- 
dency of the extremities to become cool. 

3. The most careful attention should be given to the nourishment of 
the patient from the first. 

4. Adynamic symptoms should be anticipated by the free use of 
stimulants and tonics, and the application of artificial heat if necessary. 

DRS. J. BENZON, OF BUCCARI, AND S. KORACH, OF COLOGNE. 

These gentlemen have both been using iodoform locally in diphtheria 
with success (Deutsch. Med. Woch., 1882.) The former treated one 
man. two women and two girls, respectfully aged eighteen and twenty- 
two, and a four-year-old child; and notwithstanding the cases were all 
of a grave type, under the local treatment mentioned they all ran a 
favorable and rapid course. Buccari treated his cases as follows : 
He took a painter's brush, one ctm. wide, and dipped it into finely- 
powdered iodoform until the points were all colored yellow. He then 
depressed the back of the tongue and applied the iodoform to the 
diphtheritic membrane. This procedure was repeated, in the beginning 
of the disease, about eight times during the day and six times during 
the night. With the exception of ice applications to the neck, this con- 
stituted the whole of the treatment. For nearly a year all the diph- 
theria patients in the Cologne City Hospital were treated in this way, 



158 DISEASES OF CHILDREN. 

cleansing injections with unmedicated water being the only local or 
internal medication used besides. The results were very satisfactory, 
for in 213 cases there was only one death. 

DR. J. H. VOJE, OF FREDONIA, WISCONSIN, 

Has tried this remedy successfully on a number of cases. 

DR. JAMES BATES, OF PARIS, OHIO, 

Also has found it very useful (Medical and Surgical Reporter , 1883). 
By these gentlemen it was also dusted or blown on to the diseased sur- 
face. 

DIPHTHERITIC PARALYSIS. 

DR. ARCHAMBAULT, OF PARIS. 

This distinguished authority tells us that attention must first be paid 
to the general health, for such patients are usually in a state of pro- 
found anaemia when convalescent from a more or less intense attack of 
diphtheria. They are pale and feeble, and you will generally find a 
blowing murmur in the cervical vessels. And this anaemic condition is 
generally more marked in cases where paralysis follows diphtheria, so 
that he is in the habit of giving the muriated tincture of iron to such 
patients, in doses of from five to fifteen drops. In conjunction with 
iron, he has found the arsenical preparations of great advantage. The 
preparation most frequently employed in the Hopital des JEnfants 
Malades, is the liquor potassii arsenitis, or Fowler's solution, of which 
the dose may be carried, without difficulty and gradually, to ten or 
twelve drops per diem, for a child of from five to eight years of age. 
The two medicaments may be given conjointly at meal times, in a little 
wine. 

The syrup of the iodide of iron and the ferruginous elixir of M. 
Rabuteau also answer all the indications for treatment. He also ad- 
ministers during the day, by dessertspoonfuls, a brandy mixture con- 
taining thirty grains of extract of quinquina (Fr. codex), and eight or 
ten minims of tincture of mix vomica. If the tincture induces vomit- 
ing, it may be necessary to omit it, or it may be advantageously re- 
placed by some preparation containing sulphate of strychnia, such as 
the syrup of the French codex, which contains ih of a grain in one 
teaspoonful, and is easily taken and well supported by the stomach. 
At the same time the more generous wines may be allowed. 



DIPHTHERITIC PARALYSIS. 159 

When the paralysis is generalized, he makes use of the continuous 
electric current, placing the positive pole over the cervical region and 
the negative at the lower part of the vertebral column, or on one of 
the limbs. 

M. Trouve has constructed small electric machines of six elements, 
which are not above the means of most families, and nothing is more 
simple than to instruct some one about the patient in the use of this 
little apparatus. 

These continuous currents may be maintained for hours if but four 
elements are used ; when six are employed the machine should not be 
left so long in action. 

When he considers that the diaphragm is enfeebled, he makes use of 
electricity, so that the current will traverse that muscle ; and in the 
same way when there is paralysis of the intrinsic muscles of the larynx. 
In order to act on the nerve extremities, and, consequently, on the 
paralysis, dry friction or massage should be made over the entire body, 
with the hand simply covered with a glove or with a soft woolen brush ; 
frictions with a horse-hair glove are much too rude. The woolen glove 
used for the frictions may often, with advantage, be first wetted in some 
alcoholic solution ; in such case the massage produces a sensation of 
cold, which is soon followed by general reaction, which much invigorates 
the patient. 

Or a large flannel gown may be made so as to fasten about the child's 
neck, and he may then be subjected to a species of vapor bath, gum 
benzoin or juniper berries being burned on a small brazier placed so 
that the fumes mount under the gown ; while this is going on the little 
patient can be vigorously rubbed through the flannel. When recovery 
is slow and the season permits, nothing is more apt to hasten it than a 
sojourn at the seaside, with sea bathing. 

When paralysis of the pharynx induces pronounced dysphagia, it 
should receive most careful attention from the physician, particularly if 
tracheotomy has been performed and the wound in the throat is still open. 
Remembering that compact substances are most easily swallowed, 
thick soups and macaroni cooked in milk may be given, and drinks may 
be administered slowly with a spoon. If the wound in the trachea is 
still open, it will be necessary to occlude the orifice while the child 
drinks, for deglutition is easier where this is done. But the children 
are often completely spent by fruitless endeavors to satisfy their thirst, 
and also fatigued by the constant fits of coughing at each attempt to 



■^■i 



160 DISEASES OF CHILDREN. 

swallow, so that they finally refuse all species of liquid, and there is 
great difficulty to introduce sufficient food to keep them alive. Iu such 
cases very thick soups may be given, which are at the same time an 
aliment and a drink. These may be thickened with the different 
lichens, Irish moss, etc., or with gelatine. 

When the patient can swallow nothing, it becomes necessary to in- 
troduce food by means of the oesophageal tube, which is not always 
easy to pass into children. The soft rubber oesophageal tube, such as 
is made at present, should be used so as to avoid all chances of injuring 
the soft parts. Concurrently with these means of sustaining the sys- 
tem, analeptic enemata, particularly those compounded with the different 
peptones, are of very great benefit. Such an enema may be made up 
as follows : 

189. R . Salep, gr. xxx 

Thin beef soup, without salt, J ivss 

Yolk of egg, No. j or ij. M. 

By means of an electric current passing by the larynx, deglutition 
has been facilitated, and the contractility of the intrinsic muscles of the 
larynx awakened. The paralysis of the diaphragm should be combated 
with perseverance, by means of the electric current, and this paralysis 
should receive special attention, as it is one of the direct causes of 
death. 

Strabismus and blepharoptosis should also be treated by electricity ; 
but here there is less urgency, as these are of little importance, and 
always finally disappear. The visual troubles induced by the default- 
in accommodation are corrected by a collyrium containing eserine : 

190. R. Sulphate of eserine, gr. v 

Aquae destil., f.gj. M. 

A few drops in the eye, morning and evening. 

Here again there is little need of therapeutic intervention, for the 
visual troubles are always fugacious, and disappear completely after a 
certain length of time. 

DR. H. CRIPPS LAWRENCE, OF ENGLAND. 

This author {British Medical Journal, 1882), has had good re- 
sults from the use of the glycerols of tannin and carbolic acid. 

191. R . Glycerinse acidi tannici, 3vij 

Glycerinse acidi carbol., 3J- M. 



DIPHTHERIA. 161 

In the application of glycerine as an absorbent, it is of practical im- 
portance that a small proportion of water should be added to it. In 
order to secure this, a sufficiency of glycerine should be placed in a 
saucer, and a throat-brush dipped in water should first be stirred into 
the glycerine before applying it to the throat and fauces. The combi- 
nation above mentioned has been found practically the most efficient 
proportion for securing the necessary astringent and antiseptic results, 
without irritation. An application, twice or at most thrice, in the 
twenty -four hours, secures the utmost benefit the remedy affords. It 
is seldom that any additional local remedies are required, but it is wise 
to precede the application of the glycerols with gargling the fauces and 
washing out the mouth with a solution of permanganate of potash and 
water, and to use the sulphurous acid spray, the double advantage that 
follows being that the fauces are the better prepared to benefit from the 
glycerine, and that the safety of the practitioner is increased in the 
event of the patient expectorating any false membrane during the act 
of swabbing To further increase the safety of the medical attendant, 
a glass screen placed between him and the patient will afford protec- 
tion, without limiting the efficiency of the procedure. 

DR. DEUKER, OF RUSSIA. 

This physician {Medical Press, 1882), who, during twenty -four 
years of very extensive practice in the Children's Hospital, St. Peters- 
burg, has treated upwards of two thousand cases of diphtheria, and 
tried all the remedies, both external and internal, recommended in this 
affection, has obtained the best results from the following method, which 
he has employed for the last ten years. As soon as the white spots 
appear on the tonsils, he gives a laxative, mainly composed of senna, 
which produces an abundant watery evacuation. When the purgative 
effect has ceased, he gives cold drinks, acidulated with hydrochloric 
acid, and every two hours a gargle composed of lime-water and hot 
milk in equal parts. 

DR. H. L. GETZ, OF IOWA. 

This author {Medical and Surgical Reporter, 1882), relies upon 
the following plan of treatment : 

Locally, internally, tincture of iron with glycerine, in the proportion 
of two parts of the former to one of the latter, and this mixture satur- 
ated with chlorate of potash ; this should be carefully and thoroughly 
11 



162 DISEASES OF CHILDREN. 

applied, every six hours, to the fauces, tonsils, etc., by the physician, 
and never entrusted to inexperienced persons. A gargle consisting of 
one part of the above mixture and three parts of water should be used 
every two or three hours. Small pieces of ice may also be allowed to 
dissolve in the mouth to good advantage when not annoying the patient. 
Locally, externally, nothing, except where there is swelling of the 
lymphatics ; then the application of liniment of ammonia. 

DR. MORELL MACKENZIE, OF LONDON. 

This distinguished authority says (Medical and Surgical Reporter, 
1881,) that so far as local treatment is concerned he places his sole re- 
liance on varnishes, i. e., remedies which exclude the air from the false 
membrane, tolu dissolved in ether being the most useful. Dr. Dix, a 
Danish medical practitioner scrapes away the false membrane and 
cauterizes the scraped surface with solid nitrate of silver. 

DR. JOHN A. LARRABEE, OF KENTUCKY. 

This author (Philadelphia Medical Times, 1881,) lays down the 
following rules — muriated tincture of iron, persistently and freely given, 
should form the basis of treatment ; its astringent property tends to 
prevent the formation of the membrane, while its eifects upon the con- 
stitution tend to sustain the life of the patient, and thus enable him to 
throw off the membrane. He also recommends the free use of alcohol. 

DR. JOSEPH H. WARREN, OF BOSTON. 

This author ( Virginia Medical Monthly, 1880,) has been using the 
following with greater success than he ever achieved with any other 
form of medication. 

192. R. Glycerinae, f. gij 

Acid, thymic, gr. iv-vj 

Potass, chlorat, 3iJ ss 

QuiiiiaB bisulph., % ss-j 

Brandy, (very old) f-S v J« M. 

S. — To a child from one to two years old up to five, a teaspoonful every 
hour or two, according to the urgency of the disease. Increase the dose 
from this age upward to f. £iv. Let the patient take it without any 
water, if possible, as by so doing, he will get the stimulating effect on 
the throat and thus avoid the use of anything for a gargle. 

For atomizing the throat, he uses the following: 



u\. r a xxl.ej.lvx a . 

193. R . Glycerin®, 


f.,lj 




Acid thymic, 


gr. vi-x 




Soclii borat., 


^iv 




Aquae cam phone, 


f.Siv 




Aquae picis liquid®, 


f.gv. M. 


Filter. 


S.— Atomize freely every two or three hours. 







DR. J. R. BLACK, OF OHIO. 

This physician considers that he has a very potent local application in 
the following (Medical and Surgical Reporter, 1880,) 

194. R. Glycerin®, f. gss 

Tr. iodinii, f. 3 ss 

Acid, salicylic, gr. xx. M. 

It should be applied freely, with a large camel's hair brush, morning 
and evening, carefully covering the whole of the diphtheritic surface 
with it. When the disease extends up into the nasal cavities, the use 
of the camel's hair brush is impracticable, and he usually relies upon the 
use of an injection of a liquid, containing one fluid drachm of the solu- 
tion of carbolic acid to seven fluid drachms of a saturated solution of 
chlorate of potassium. 

DR. J. W. MOORE, OF COHOES, N. Y. 

Dr. J. W. Moore says that in lis hands the following line of treat- 
ment, which he publishes in the Med. Annals, 1884, has been almost 
uniformly successful in the cases that he has treated during the past six 
months, the rate of mortality being two to thirty, these two dying from 
fibrinous tracheo-bronchitis. After attending to the hygienic necessities 
as far as possible, such as putting the patient in a well-ventilated room, 
the air of which is both warm and moist, with the temperature between 
60° and 65° (assuming that we are able to put our patient in a com- 
fortable room, as often we have to treat them as we find them), and thin 
patches of false membrane presenting themselves, with other concomi- 
tant symptoms, he gently sprays the throat with a weak solution of 
chlorine gas, made by the action of tr. chlor. iron on potassium chlorate, 
slowly adding water as the chlorine is given off. He then gives, accord- 
ing to age, from ten to fifteen drops of the tr. of iron every three hours 
in a little glycerine and water ; good nourishing diet, such as milk, 
eggs, etc. On the second day, if the disease is not checked, he givea 
one drop of Lugol's solution of iodine, and a half drop of carbolic acid, 
in a little water and glycerine, every two hours, and increases the 



164 DISEASES OF CHILDREN. 

intervals of the iron to four or five hours. He also uses a direct appli- 
cation, discarding the spray, of a mixture of iodine, glycerine, and car- 
bolic acid. 

DR. ROBERT J. CULLEN, OF NEW YORK. 

This author states, in the Medical and Surgical Reporter, 1880, 
that he has treated about eleven hundred cases of diphtheria, and has 
cured about ninety-eight per cent. His treatment consists in adding 
one dcop of dilute nitro -muriatic acid to every teaspoonful of the fol- 
lowing mixture : 

195. R . Potassii chlorat., % iij 

Tinct. ferri chlor., f-£iv 

Aquse, 
Glycerinse, all f. gij. M. 

S. — Teaspoonful every fifteen minutes. 



The arrest of the disease and nutritious support, our author claims, 
in the Lancet, 1879, are our great aims. For this purpose he has 
adopted a respirator, made of the ordinary shape and size, the front 
being minutely perforated. Inside of the respirator, he has two or 
three perforated plates inserted, between which he places common tow 
(not cotton wool). He then drops on each of the layers of tow ten to 
twenty drops of a solution of carbolic acid, creasote, and glycerine. 
Should the patient tire of these, he uses turpentine or iodine. He 
places the respirator over the mouth and keeps it continually applied. 
He keeps two kettles of water boiling on the fire. Attached to the spouts 
of the kettles he has an elastic tube of an inch calibre, at the end of 
which is a spray-like nozzle, which he puts immediately under the 
mouth of the patient. By this means the disinfectant remedies are 
carried \noist to the throat. Previous to this, he gives an active purge, 
which usually removes offensive stools, of effete, poisonous matter. 
Internally he gives aconite, in frequent small doses. At the same time, 
the strength is supported with milk, cream and eggs, with or without 
brandy, and beef tea ad libitum. As a drink, he recommends patients to 
take as much chlorate of potash in solution as they can without vomiting. 
If this is objected to, he orders lemon juice. If the system is very 
weak, he gives belladonna in lieu of aconite. As soon as the urgent 
symptoms have subsided, he orders strychnia, with or without nitro- 
muriatic acid. He never forgets bicarbonate of potash, on account of 
the tendency to rheumatism after this disease. 



DIPHTHERIA. 165 

DR. RUDOLPH SIEFFERT, 

writes to the Chicago Medical Journal and Examiner, 1880, that 
his main remedy in the treatment of this disease, is the inhalation of 
carbolic acid, diluted, through a sponge. The sponge is saturated with 
a solution of carbolic acid (the strength ranging from 1 part in 200 to 1 
part in 100 of water), and then placed in a wire holder, formed so as 
to fit over mouth and nose. This inhaling apparatus is fastened to the 
patient's mouth and nostrils, so that respiration must take place through 
the carbolated sponge. These inhalations are repeated every two 
hours, each lasting about half an hour. Within twenty-four hours, the 
membranes become loose, and are gradually either swallowed or ex- 
pectorated, and they do not reappear with the same severity. In the 
cases of larger children, he orders the throat to be gargled with warm 
chamomile (German) tea. After every application, the sponge ought 
to be well washed in hot water, and if there be several patients in the 
same family, each one ought to have its own apparatus, or at least its 
own sponge. To prevent the carbolic acid solution from affecting the 
lips, it is well to oil the lips before applying the inhaling apparatus. 
Besides the inhalation, he uses quinine, and, in order to keep the bowels 
open, the fluid extract of rhamnus frangula. With older children, he 
occasionally orders gargling with a weak solution of carbolic acid. 



In the early stages this author recommends ( Virginia Medical 
Monthly, 1879,) small doses of calomel and ipecac every two hours, 
say from one quarter to one grain of the first and one-quarter to one- 
sixth of a grain of the latter ; this will be much more efficient if used in 
connection with effervescing citrate of potassium. He orders two 
drachms of citric acid and the same quantity of bicarbonate of potas- 
sium, dissolved in separate tumblers of water ; the former may be 
sweetened to render the mixture palatable. A tablespoonful of each 
solution mixed together and in effervescence, should be taken every 
hour; and every second hour, if fever is high, from ten to twenty drops 
of antimonial wine, according to the age of the patient, should be added 
to the dose. 

By the persistent use of this treatment, he has generally found that 
in twenty-four hours the fever will be considerably reduced, the tongue 
moistened, and often three-fourths of the deposit removed from the 



166 DISEASES OF CHILDREN. 

throat. If, however, after the subsidence of the fever and the improve- 
ment of the throat, the deposit in part obstinately adheres, he discon- 
tinues the calomel and ipecac, and uses in place of them muriated tinc- 
ture of iron, in ten or twenty-drop doses, regularly continuing the 
effervescing preparation throughout the disease. 

If, in forty-eight hours, no improvement of the throat appears, occa- 
sional cauterization with nitrate of silver, or a strong solution of sulphate 
of zinc — say twenty grains to Sj water — applied by a camel's hair 
brush, has almost invariably accomplished the desired effect. 

DR. S. MURDOCH, OF MISSOURI. 

This author states, in the St. Louis Courier of Medicine, that he 
has long since abandoned all swabs, and the use of tincture of iron, or 
iron in any of its forms, believing it to be one of the most mischievous 
remedies ever given in this disease, and he depends principally upon 
chlorine mixtures and supportive treatment. 



Dr. Gasparini (Gazz. Med. Ital. Lomb., February L6, 1884,) ac- 
cepts Morell Mackenzie's definition of diphtheria, and looks upon it as an 
acute infectious general disease, with a tendency to the production of 
certain local manifestations. His treatment consists in wrapping the 
patient in a cold wet sheet, repeating the packing three or four times a 
day, according to the height of the fever. Cold compresses are to be 
kept continually to the throat. He also uses gargles of the alkaline 
sulphites, carbolic acid, etc., as disinfectants, never caustics. In 1875, 
six cases were thus treated ; all recovered, the disease lasting from five 
to eleven days. In 1879, seven cases recovered under the same treat- 
ment, the average duration of the disease being ten days. This treat- 
ment is well borne, and the patients like it ; its antipyretic action is 
marked, though transitory. Stimulants are at the same time to be 
freely administered. The duration of the disease is not influenced ; 
but convalescence is shortened, and the strength is more quickly re- 
covered. 

M. DELTHIL, OF FRANCE, 

burns in the sick-room QDeutsch. Med. Zeit., 1881,) an equal mixture 
of coal-tar and ol. terebinthinge, causing the formation of thick, black 
vapor. The air of the room becomes impregnated with carbon in various 



DIPHTHERIA. 167 

combinations, and the latter are said to dissolve the fatty substances 
which unite the constituent parts of the diphtheritic membranes. In 
consequence of this chemical action it is believed the membranes lose 
their tenacity and their adherence to the tissues, and their expectoration 
is easier. 

He tried this method on four children, on whom, on account of laryn- 
geal diphtheria, tracheotomy had been performed. Three of the patients 
died. But remembering the fatality usually attending cases of this 
kind, the result is, if anything, favorable. Dr. Fereol employed the 
same treatment on an adult-, suffering from a mild type of the same 
disease. After each fumigation, which was very well borne by the 
patient, free expectoration ensued, and on the second day the mem- 
branes had become soft and were much less adherent. 

DR. GEORGE A. LYNN, OF PENNSYLVANIA. 

This author, in a paper read before the American Medical Associa- 
tion, 1884, sets forth the proper mode of administering corrosive subli- 
mate in diphtheria. In order to make it thoroughly reliable and valu- 
able, he says : 

1. It must be used in the first stage of the disease. 

2. It must be used in large doses frequently repeated. 

The first rule is apparent, he thinks, from the fact that the greatest 
value of the medicine is in the prevention of the formation of the poison 
in the membrane, and it should not be put off until all other remedies 
have been tried and failed. The effect of the remedy, given early, is to 
reduce the temperature, relieve pain in the head, back and limbs, unlock 
the secretions, lessen the soreness in the throat, in time to relieve the 
nausea and vomiting. He advises as the best mode of administering it 
that a solution be made of one grain of the bichloride to one drachm of 
alcohol. He recommends as a vehicle for the bichloride, an elixir of 
pepsin or of pepsin and bismuth. To a child of three years, he gives 
from xV to T2 grain according as the disease is mild or malignant, re- 
peating the dose every three hours. To an adult, tg to j grain may be 
given at the same intervals. He states that in mild cases convalescence 
is generally established by the end of the third day, when the treatment 
is commenced early and that it is seldom necessary to continue it more 
than five days. When this treatment is instituted early, nothing else is 
found necessary. In cases where it is not commenced until late in the 



168 DISEASES OP CHILDREN. 

course of the disease, it may be necessary to give tonics and stimulants, 
as tincture of iron and brandy. In some cases membrane has already 
formed before the physician is called to see the case or before the 
remedy has had time to take effect ; and then, if it affect the larynx or 
trachea, a new danger arises from the mechanical obstruction for which 
the corrosive chloride gives no relief. In many cases of croup, simple 
or diphtheritic, dyspnoea is due not to the mechanical obstruction pro- 
duced by the membrane, but to a spasmodic condition of the glottis. 
Dr. Lynn thinks that a remedy which will relieve this spasm, will obvi- 
ate the necessity of resorting to tracheotomy in nearly all cases. He 
believes that we have such a remedy in the chloride of gold. He 
directs the druggist to dissolve the contents of a fifteen-grain bottle as 
it comes from the manufacturer, in fifteen drachms of distilled water and 
to dispense from that solution. The dose may be sV-sV grain and may 
be administered easily in water, as it is almost tasteless. It should be 
given from a glass or a teacup, as the preparation acts readily upon 
metals, especially upon silver. 

DR. W. B. POWELL, OF LOUISIANA, 

uses the treatment recommended by Dr. Maynard, and in addition 
(Medical and Surgical Reporter, 1881), uses the muriated tincture 
of iron and chlorate of potassium, both externally and internally, as 
follows : 

19G. R. Tinct. fcrri mur., f.3ij 

Potassii chlorat,, 5j 

Aquie purse, J'-5'v. M. 

S. — One teaspoonful according to age of patient every three hours. 

Many little ones are unable to gargle or rinse their throats, hence, 
when the preparation is swallowed, it comes directly into contact with 
the diseased membrane, both in the front as well as in the back of the 
throat. Before using the solution, he orders the inhalation of equal 
parts of good vinegar and hot water (a common vessel, with a spout, 
where a good inhaler cannot be had, will do) ; this vapor softens the 
membranes. He also gives quinine, in appropriate doses. 

M. DE BLEYNIE, OP FRANCE, 

strongly advocates the "ice" treatment of diphtheria (Medical and 
Surgical Reporter, 1881). The following mode of administration is 
recommended: 1. Introduce into the mouth of the little patient, a small 



DIPHTHERIA. 169 

fragment of ice every ten minutes, without any interruption whether 
the child is awake or sleeping. 2. Do not cease giving ice until the 
false membranes have entirely disappeared; this happens from the 
second to the eighth day. 3. Keep good watch over the throat, and 
if the membranes reappear, recommence the treatment. 4. From the 
beginning give wine and good nourishing food. 



When first called to see a patient, this writer {Medical and Surgical 
Reporter, 1881,) directs that the bowels be properly evacuated. 
After the bowels are evacuated, or before, if the case is urgent, or the 
general indications do not forbid, he prescribes a sedative, diuretic and 
diaphoretic, in the form of the original Dover's powder, or as follows : 

197. R. Pulv. ipecac, 7)ss 

Potass, nit., 3J. M. 

Ft. pulv. No. x. 
S. — One every two or three hours. 

Or a stimulating diuretic and diaphoretic, in the form of hot water, 
whisky and sweet spirits of nitre, flavored to suit the taste, and duly 
proportioned to meet the indications. Give it hot, sw r eet and strong 
enough to slightly inebriate, and it will rarely fail to produce profuse 
diuresis and diaphoresis. He applies freely to the parts covered with 
false membrane, pure carbolic acid liquefied by heat. He urges us not 
to be afraid to use carbolic acid in its purity, for it never burns deep, 
and the pain from its application does not last long. For internal 
medication he gives : 

198. R. Potass, chl or., £j 

Tr. ferri mur., f. ^ss 

Alcohol, f. 3 j 

Syr. simpl.j q. s. ad f. % iv. M. 

S. — Teaspoonful every two or three hours in a little water. 

DR. PERCIVALL, OP MARYLAND. 

This author {Medical and Snrgiccd Society of Baltimore, 1881), 
prefers nitrate of silver for local use (5j to w^ater §j). As prophylac- 
tics he uses the best of food and brandy. Dr. Erich {Ibid.) thinks 
that when we use nitrate of silver, the struggling of the child does as 
much harm as the medicine does good. He has ceased to dread the 
disease since he commenced the following treatment: 



170 DISEASES OF CHILDREN. 

199. R. Quiniae sulph., gr. viij 

Tinct. ferri chlor., f. gj 

Syr. simpl., f-3 iv « M. 

S. — Teaspoon ful every hour, day and night. 

When the disease is in an advanced stage, he alternates this mixture 
with a solution of benzoic "acid, which seems to relieve the constitu- 
tional symptoms. Dr. Morris (Ibid.) has dispensed with the use of 
iron, quinine, and local applications, and in their place uses ice, food 
and lemon juice freely, with which he has had better success than 
formerly. 



This author describes, in the Michigan Medical News, 1881, his 
treatment of diphtheria as follows: He attends to four points. 1. 
Hygiene ; 2. general health ; 3. the throat ; 4. counter-irritation. 

1 . He insists on great cleanliness of person and surroundings ; a 
moist atmosphere, easily obtained by mopping the floor and keeping a 
milk-pan of water on the stove ; and a disinfectant, produced by half 
filling an old milk-can with moist earth, placing it under the stove, and 
putting into the moist earth fifty or sixty matches (generating ozone) 
and thirty or forty drops of carbolic acid, renewed three or four times 
a day. 

2. For general symptoms, such as high pulse, pain in back, dry skin, 
increased heat, general uneasiness and glandular throat swelling, he 
gives one dose of calomel, five to tw r enty or thirty grains, followed in 
about six hours by a dose of castor oil. 

8. For the throat he orders: 

200. R. Acid tart., gr. iij 

Potass, chlorat., gr. iij 

Aquae, f . ^ ij. M. 

He orders one teaspoonful to be mixed with two teaspoonfuls of the 
coldest water that can be had ; two teaspoonfuls are to be used as a 
gargle, and the remainder swallowed. This is to be repeated every 
twenty or thirty minutes until the urgent symptoms subside. He 
usually finds the urgent symptoms relieved in twenty-four hours, when 
he gives a gargle composed of 

201. R. Capsici, gr. x 

Sodii chlorid., gr. xxx 

Aquae, % teacup. 



DIPHTHERIA. 171 

To be used freely, and if the tonsils remain enlarged and flabby, 
finish off with two or three applications of a strong solution of nitrate of 
silver, three or four grains to the drachm, applied with a feather. 

4. Counter-irritation. He folds a handkerchief so that it will lie 
well into the throat ; he then wets it in hot water, so hot as almost to 
scald, and sprinkling it with a teaspoonful or two of kerosene, places it 
quickly on the throat and covers with a dry cloth. This may want re- 
newing three or four times, at intervals of six or eight hours. When 
blistering occurs, he continues the process, but puts a little sweet cream 
on the wet cloth, instead of kerosene. 

DR. J. R. PAGE, OF BALTIMORE. 

This author (Medical Record, 1881,) strongly recommends the 
topical use of fresh lemon juice as a most efficient means for the removal 
of membrane from the throat and tonsils. In his hands (and he has 
heard several of his professional brethren say the same) it has proved 
by far the best agent he has yet tried for the purpose. He applies the 
juice of the lemon, by means of a camel's hair probang, to the affected 
parts, every two or three hours. 

DR. BLOCH, OF FRANCE. 

In La France Medicate, 1880, this author states that he has long 
employed as his principal treatment in diphtheritic angina, dry cubeb 
pepper, applied to the throat by means of a brush, and has obtained 
from it excellent results. He orders the application to be made every 
hour, with the administration of liquid food, wine, bark, etc. The false 
membranes are detached and not reproduced. The application causes 
retching — sometimes vomiting. 

These contractions of the pharynx are probably one of the elements 
of success. The absorption of the cubebs which the patients swallow 
also acts ; this remedy has long been administered internally in mem- 
branous angina, and with satisfactory results. Lastly, the topical sub- 
stitutive action has an important part in the happy effect of this treat- 
ment. It is easily used, and parents can themselves apply it to their 
children's throats. In catarrhal and pultaceous angina the same treat- 
ment succeeds marvelously — much better than alum, chlorate of potash, 
borax, tannin, etc. 



172 DISEASES OF CHILDREN. 

MERCY HOSPITAL, CHICAGO. 

In this institution (Medical and Surgical Reporter, 1880,) diph- 
theria is treated as a general disease, with more or less intense local 
manifestations. The indications arc for supporting measures for the 
genera] constitution, with treatment for such local symptoms as may 
aviso. Good alimentation by soft articles of food is directed. The 
blood poisoning is treated with an antiseptic solution containing the 
chlorate of potash and hydrochloric acid, which latter also increases the 
plasticity of the Mood. It also, in the act of swallowing it, produces a 
local astringent and antiseptic effect upon the mucous membrane of the 
fauces. To this solution the tincture of belladonna is added, because of 
its known power to produce contraction of the arterioles of the mouth 

and pharynx, and SO possibly lessen the amount of exudation. This is 

administered in frequent small doses, to obtain its maximum local effect. 
After the exfoliation of the membranes begins it is discontinued, and a 
combination of the tincture of iron and chlorate of potash is substituted. 
When the cervical glands become swollen, the following infusion is 
made : 

(!ms. or 0.0. 

202. R. Aeoniti Minium, 82.00 

A mmonii cbloridi, LG.OO 

Aquas bullientis, 356.00. M. 

Flannel cloths are wet with this hot solution and applied to the neck. 
This is covered with another dvy cloth, so as to retain the heat as long 

as possible. This has also been very edieaeious in relieving aeute 

tonsillitis and other similar inflammations in the cervical region. A 

Stimulating liniment is sometimes used in its stead. 
M. OREQUY, OF FRANCE. 

This author (La France Midicale, 1880,) commences his treatment 
by removing the false membrane with forceps; he endeavors, by a 
twisting movement, to remove the membrane, without breaking it, in as 

large a piece as possible ; he then, with a sponge, dabs the denuded 
mucous surface with a solution of tannin. 

nit. EDWIN BURD, of low A. 
This physician highly recommends hyposulphite of soda. Jhs treat- 
ment is as follows: 



DIPHTHERIA. 173 

203. U. SodsB hyposulphis, Bviij 

Quiniee sulphatis, S *s 

Spirit us frumenti, ('. r>i v - M. 

Slg. — For a child five yours of age, ono tcaspoonful every four hours, day 
and night. 

204. \l. Potass» chloratis, $ij 

Tr. ferri ohloridi, i. ,)i.j 

Syr. simplicis, f. 5 iv. M. 

Sig. — One teaspoonful every four hours, day and night. 

Insufflations of sulphur to be used several times a day. Food is 
urged upon the little patients in as large quantities as can be digested. 

hi all cases where the above treatment lias been strictly carried out 
from (he start, the result lias been surprising. The spread of the 
exudation is at once arrested, and prostration does not ensue. The 
fetor of the breath also soon leaves, and the patient soon becomes 
bright and cheerful. If applied as soon as the first signs of exudation 
appear, the whole proeess seems to end right here, and in a few days 
tlu v patient is well, with no unpleasant sequelae. 

M. PERATK, OF FKANCE. 

M. PERATis has, according to Bulletin de TMrapeutique, 1880, for 

the last two years used carbolized camphor for the treatment of diph- 
theria. He paints the surface with a pencil dipped in the following 
mixture : Carbolic acid, V grams; camphor, 25 grams; alcohol, 1 gram? 
diluted with equal parts of the oil of sweet almonds. The paintings 
are made every two hours in the day, and every three hours in the 
evening: then, after some days, they are divided by periods of three, 
four, or live hours, according to the improvement of the patient. These 
paintings are made over the whole extent of the false membranes, and 
with troublesome children the pencil is plunged as deeply as possible to 
the bottom of the throat, being of course, previously drained. The 
mixture lias an extremely disagreeable taste, to which, however, the 
patient soon becomes accustomed. M. LV.katk has been very success- 
ful with this plan of treatment. 



This author describes (^Proceedings Medical Society of the County 

of Kings, L881,) his process o\^ using electricity in this disease as 
follows: 

lie places the feet of the patient in a bath of water as hot as it can 



174 DISEASES OF CHILDREN. 

be borne with comfort, and puts in that water one, two or three table- 
spoonfuls of saleratus. He then takes a glass of cold water and puts 
some saleraius in it, and with this solution wets the electrode which is 
to be applied to the throat. The negative pole of the battery is put 
into the bath in which the feet are placed. The positive is to be 
covered with cotton and used in the throat, on the tongue, and in the 
nose if it be needed there. Of course the sponge handles or ordinary 
electrodes cannot be used in these localities ; but a very convenient one 
for the mouth and throat is made by covering the blade of a dinner 
knife with a thin layer of cotton, which is to be soaked with the solu- 
tion of saleratus. The cotton also serves to keep the soft parts of the 
mouth and throat from direct contact with the metal, which otherwise 
would cause pain. The mouth should be kept open, so that the teeth 
will not touch the electrode. A convenient electrode for the nose is 
made by winding a thin layer of cotton on a wire. 

Thus prepared, the patient is seated in a chair, if able to sit up. The 
feet are placed in the bath, and the patient holds in his lap a basin to 
catch the saliva as it flows from the mouth, or as he has occasion to spit 
it out. The physician should be careful not to sit in front of the 
patient, for fear that the patient will cough and blow his poisonous se- 
cretions in his face. Sitting near the right side of the patient, he dips 
the electrode into the saleratus water to wet the cotton ; then placing it 
on the tongue, he holds the knife by its metallic handle in the left 
hand, while he lays the right hand very gently on the sponge of the 
positive electrode. TJie current will now pass through the operator, 
and he can regulate the power of the current to the ability of the 
patient to bear it without pain. If he wants a stronger current, he can 
grasp the sponge a little tighter. As soon as the patient becomes ac- 
customed to the current on the tongue, the operator may pass it (the 
electrode) gently up the side of either tonsil. Watching a good oppor- 
tunity, he can now pass it back to the posterior wall of the pharynx, 
and even down to the epiglottis. This last position is likely to make 
the patient cough, and will, in some instances, make him vomit. In 
either case mucus in large quantities will be thrown out, and it will be- 
come necessary to remove the electrode ; but before this is done the 
current should be broken by raising the right hand from the sponge 
electrode. The cotton on the electrode should be secured by winding 
a little thread around it, and the operator should be careful not to let 



DIPHTHERIA. 175 

the electrode touch the teeth, as that will cause pain. If the current 
passing through the operator be too weak, he may bring the positive 
sponge up and touch the handle of the knife. The electrode must be 
removed occasionally, to give the patient a chance to breathe, to spit, 
etc. It is not necessary to use a strong current. The electrode for 
the nose can often be passed back as far as the posterior wall of the 
pharynx. 

Along with other remedies to support the system, electricity will 
prove useful, as it stimulates the secretions. 

PROFESSOR VIDAL, OF PARIS. 

This author employs the following in diphtheria, and claims for it an 
almost specific action : 

205. R. Acid, tartaric, ^i.l'ss 

Glycei inse, f. % ss 

Aq. meutli. pip., f.3 vi J' ^« 

A brush, dipped into this solution, is made to touch, every three 
hours, the diphtheritic patches, which soon reduces them to a pulpy 
liquid mass, which is afterwards easily removed. In the intervals of 
the application of the tartaric acid, the false membranes are touched 
with citron juice. 

TRACHEOTOMY IN DIPHTHERIA. 
PROFESSOR BUCHANAN, OF GLASGOW. 

This author considers (Proceedings International Medical Con- 
gress, 1881,) that tracheotomy is justifiable in diphtheria as well as in 
croup, but only in the sthenic or simply suffocative form. The type and 
stage of the disease demanding tracheotomy was best recognized by 
observation of the naked chest. The operation should be performed 
with the utmost deliberation, and the higher up the trachea the better. 
In the after-treatment all medicine should be abandoned, and reliance 
placed solely on nourishing food, with copious supply of fresh air, at a 
proper temperature, the moisture being secured by a porous sponge, 
kept moist and hot, or a little loose gauze placed over the mouth of the 
tube, which should be kept scrupulously clean and clear. 

DR. E. E. MONTGOMERY, OF PHILADELPHIA. 

In operating, this author (JSIed. and Surg. Reporter, 1884,) gives 
chloroform, and avoids hemorrhage by transfixing a fold of the skin, 



176 DISEASES OF CHILDREN. 

held by himself and assistant, making an incision one inch long, com- 
pleting the dissection to the trachea by the forceps and grooved 
director. After opening the trachea care is observed to remove all 
membrane previous to insertion of canula. After treatment consists in 
attention to tube, keeping several thicknesses of tarletan wet with hot 
carbolized water over it. The temperature of the room is maintained 
at between 75° and 80° F., and stimulants and good food given, to- 
gether with quinia, tincturae ferri chlorid. and corrosive sublimate — the 
latter in frequently repeated doses. The attempt is made to dispense 
with the tube from the fifth to the eighth day, but it should not be re- 
moved until respiration per vias naturales is fully established. He 
formulates the following conclusions : 

1. That tracheotomy is justifiable in diphtheria as well as in croup. 

2. That it should be performed in croup when it is evident that drugs 
do not control the progress of the disease, particularly when there is 
depression of the lower end of the sternum during inspiration ; in diph- 
theria, with the advent of suffocating symptoms. 

3. That in the performance of the operation, the knife should only 
be used to incise the skin and trachea, the intervening tissue being torn 
by director and forceps. 

4. That the subsequent use of proper drugs will promote a favorable 
result. 

THE TREATMENT OF THE PARALYSIS. 
SIR JOHN ROSE CORMAC, M. D., PARIS. 

In an article on this form of paralysis, in the Edinburgh Medical 
Journal, Aug., 1876, this writer observes that iron is particularly in- 
dicated, as the patients are always anaemic. There are few cases in 
which its administration does not prove itself in an obvious manner to be 
useful in a high degree. Sometimes it is only borne in very small 
doses. 

Nux vomica, either in the form of extract or strychnia, taken daily, 
with some ordinary combination of laxatives, such as the compound rhu- 
barb pill, ought to constitute a part of the treatment in nearly every 
case. The dose ought to be moderate, for large doses prove too exciting 
to the nervous system, and so tend to exhaust rather than invigorate its 
flagging powers. From J a grain to 2 grains of the extract once a day, 
with or without the occasional or constant addition of from 5 to 10 drops 



DIPHTHERIA. 177 

of the liquor strychnine (B. Ph.,) two or three times a day, are suitable 



Local treatment is of the most importance with a view to direct 
toward the wasted and wasting muscles a greater supply of blood, and 
thereby improve their nutrition. Occasional blisters act very benefi- 
cially in this way ; but they must not be relied on to the exclusion of 
the constant use of stimulating pastes or liniments. No local stimu- 
lant is more efficacious, or better adapted for continuous use, than a 
ginger and mustard paste. The object of using the paste is to main- 
tain a warm glow in the skin without vesicating it. The potency of 
the paste must therefore be proportioned to the susceptibility of the 
skin. In some excitable patients who cannot bear long-continued 
counter-irritation of the skin, gentle kneading or massage of the 
paralyzed muscles, three or four times in the twenty -four hours, will be 
found useful as a means of directing a supply of blood to them. In 
such cases, after each kneading, a moderately stimulating liniment con- 
taining a small quantity of laudanum may be applied with great benefit. 
The laudanum prevents an uneasy, bruised feeling, which is often com- 
plained of after the kneading, and in irritable subjects is apt to induce 
restlessness and insomnia. 

Galvanic excitement of contraction in the paralyzed muscles is often 
decidedly useful; but it is a measure which requires to be employed 
with moderation, and at intervals of about twenty-four hours. If re- 
sorted to too early, or too freely, it exhausts the nervous power of the 
affected muscles. 

For the paralysis following diphtheria, the following formula (re- 
commended by Prof. Metcalfe, of New York,) is useful: 

206. R. Strychnia, gr. j 

Acidi nitrici diluti, f«3J 

Aquae, f-3 vr J- ^.. 

From three to five drops, in a dessertspoonful of water, are to be given 
three times daily to a child of three years. 

The ansemic state which succeeds diphtheria is to be remedied by 
the administration of iron for several weeks. 

NOTES ON REMEDIES. 

INTERNAL BBMEDIES. 

Acid Sulphurous is highly praised by Dr. W. W. Carpenter, of California 
{Medical Herald, 1880). 
12 



1T8 DISEASES OF CHILDREN. 

207. B . Acidi sulphurosi, 

Aquas purae, aa gj 

Glycerinae, f-o v J- M. 

S. — From one-half teaspoonful to a dessertspoonful, according to age, 
every half hour. 

Seldom is anything beyond this required. But, if the case is very 
malignant, the acid can be combined with sulphur, or a saturated solu- 
tion of chlorate of potash can take the place of the water in che above 
formula. 
Alcohol,^ ccording to Dr. E. N. Chapman, of Brooklyn, ''neutralizes the diph- 
theritic poison, sets free the nerves of animal life, subdues the fever and 
inflammation, destroys the pabulum that sustains the membrane, cuts 
short the disease, conquers its sequelae, and shields the other members 
of the family from an attack." It is also highly recommended by Dr. 
F. C. Roberts, of Fort Madison, Iowa, ( Gaillard's Medical Journal, 
1881,) who orders 

208. R . Potassii chloratis, 5 SS 

Alcohol, 

Aquae rosas, aa f-3U- M. 

S. — To be used as a gargle every half hour. 

Ammonii Murias. Dr. W. W. Oglesby, of Oregon, has had very favorable re- 
sults with this agent. He gives : 

209. R. Ammonii muriat., 

Pulv. acaciae, 

Sacch. alb., aa ^ij 

Aquae font., f'^iv. M. 

A teaspoonful every two hours. 

When the depression is marked, he adds alcoholic stimulants ; and 
for a gargle, uses chlorine water. 

ApomorpJiia, in the dose of gr. £, by the mouth, or gr. T \, hypodermically, is a 
certain, rapid, and useful emetic in diphtheria. 

Aqua Chlorinii has been found a valuable internal remedy, by Dr. J. S. Ben- 
son. (Canada Lancet, January, 1870.) He gives it in doses of a tea- 
spoonful or a dessertspoonful, to children, every three hours. In all 
cases, it should be given without any addition of water. 

Bromine is strongly recommended by Dr. Schiltz, (Pharm. Central., 1884), in 
the treatment of diphtheria. One form in which he uses it is as a solu- 
tion prepared thus : Chlorine water, 30 parts ; distilled water, 150 parts ; 
and bromide of potassium, 3 parts. The bromine, separated by the 
chlorine from the bromide of potassium, remains dissolved in an ex- 
cess of the latter, like iodine in potassium iodide. The chlorine water 
of the German Pharmacopoeia is not so strong as that of the British 
Pharmacopoeia. 

Carbolicum Acidum, gtt. j, in solution every hour, with steam inhalations, is a 



DIPHTHEKIA. 179 

plan advocated by Dr. F. A. McEwen. {Practitioner, December, 
1878.) 
Chloral Hydras. Dr. Fabbini, in Tunis, as well as several Italian physicians, 
have used with much success, in diphtheria, a solution of chloral in 
glycerine. 

210. R . Chloral hydratis, gr. xxx-xl 

Glycerinse, ^iv-v. ^- 

The dose is varied according to the age, and may be given in water, 
to the taste. 

Dr. Rokitanskt paints the throat with a fifty per cent, solution. 
Cubeba. In the early stages of the affection, M. Teideau recommends cubebs 

in enormous doses — gij to a child of one year, giss to an adult, daily. 

Other observers have spoken well of this treatment. {London Med. 

Record, July, 1877.) 
Cupri Sulphas ranks, according to Dr. W. Squibe, with alum as one of the best 

and most effectual emetics in diphtheria. He directs : 

211. R . Cupri sulphatis, gr. v 

Aquae, f. gj. M. 

A teaspoonful at a time, to young children. 

* Ferri Chloridi Tinctura is much employed in diphtheria. It should be com- 
menced on the first day of the illness, or as soon as the patient is seen, 
and continued until the tongue becomes red and the throat improves. 
When deposit has already taken place, the good effects of the treat- 
ment will be shown, not by any alteration in the size of the patch, but 
by a diminution in the accompanying secretion, and by improvement of 
the general symptoms. The iron treatment, as carried out by Dr. "Wm. 
Yeats, {Edinburgh Medical Journal, July, 1876,) is as follows: As 
soon as a case came under his notice, he prescribed, for adults, 10-drop 
doses of the strong liq. ferri perchloridi, with 10 to 15-grain doses of 
chlorate of potash, to be taken in a wineglassful of water, every two 
hours, until decided improvement was evident, when the interval was 
prolonged. The dose was modified for children, of course. Vomiting- 
was usually set up by the first two or three doses, but the patient, being 
warned of this, was instructed to persevere, and afterward there was 
no trouble in this way. Constipation was rarely complained of, and 
when it did happen, a little glycerine added to each dose obviated the 
difficulty. The local treatment was in the following form : Liq. ferri per- 
chloridi and glycerine, in equal parts, which was brushed over the ex- 
udations daily. The glycerine helps to dissolve the slough, and the 
iron hardens the subjacent surface, and considerably modifies further 
exudation. 

Guaiacum. The following: formula has been recommended : 



180 DISEASES OF CHILDREN. 

212. R. Tincturae guaiaci ammoniatae, f.gss-v 

Tincturae cinchonae compositae, f-o ss 

Potassii cliloratis, J) iv 

Mellis, q. s. 

Aquae, adf. ^viij. M. 

From a teaspoonful to a tablespoonful, from one to five hours, or 
thrice daily, according to the severity of the case. 

Guaiacum, as a gargle, in all varieties of sore throat, hoarseness, 
etc., is a remedy ol ancient and acknowledged repute. 
Hydrargyrum Uhloridum Mite, Dr. Duer, of Philadelphia, {American Supplement 
to Obstetrical Journal of Great Britain and Ireland, July, 1873,) 
highly extols the efficacy of small doses of calomel and large doses of 
the bicarbonate of soda, and the free use of nutritious food and brandy. 
He states that he has treated a large number of cases, of all grades of 
severity, by this plan, with satisfactory results. 

Dr. P. F. Whitehead combines the calomel with quinine and iron : 

213. R. Hydrargyri chloridi mitis, gr. vj 

Sodii bicarbonatis, £j 

Ferri redacti, 

Quiniae sulphatis, aa gr. xxiv. 

Enclose in twelve capsules. One every two hours. 

Under this treatment, he has repeatedly seen the pseudo-membrane 
disappear, and upon the cessation of the mercury and soda, return, and 
again disappear when the mercury and soda were resumed. The mer- 
cury and soda should be continued until after all signs of the pseudo- 
membrane have disappeared. There need be no apprehension of 
ptyalism. The excess of the alkali prevents it. {Trans. Mississippi 
Med. Soc, 1878.) 

Hydrargyrum Chloridum Gorrosidum is highly lauded by Dr. Madison Reece, 
in the Journal of the American Medical Association, 1883. He dissolves 
one grain of bichloride in four ounces of rain-water ; if the patient is 
old enough to gargle and rinse the mouth and throat, he is to do so 
every two hours, and immediately afterwards to take a teaspoonful 
internally. If the disease be severe, it should be given this way every 
hour. The above dose is calculated for a child five years of age. It 
should be continued in smaller and less frequent doses for a week or 
longer. (See also Dr. Pepper's remarks under the head of croup.) 
Dr. Hanks reports to the New York Obstetrical Society, 1884, that he 
has for two years been employing minute doses of corrosive sublimate 
internally in the treatment of diphtheria in children, and believes that 
he has obtained better results thereby than by the use of any other 
medicine. 

Hydrargyrum Gyanuretum. Dr. A. FjRichsen (St. Petersburg Med. Woch., April 
14th, 1877,) on the strength of twenty-five cases in which he tried it. 
strongly recommends minute doses of cyanide of mercury (gr. 5 1 — 2V) ^ u 
diphtheria. He believes in the efficacy of mercury abridging the dura- 
tion of the diphtheritic process, while he knows of no other preparation 



DIPHTHERIA. 181 

except this which does not quickly disturb digestion and nutrition. 
Given in small doses, it scarcely disturbs the alimentary canal at all, 
even when continued for a long time. It is highly praised by Dr. 
Sellden (Jahrb.f. Kindhlkde, 1884.) He uses a solution of -^ grain in 
three ounces of water, of which he gives two teaspoonfuls hourly, day 
and night. 

Papayotin. Schaeffer (Berlin. Klin. Woc7i., 1883,) has treated forty-seven 
cases of diphtheria with applications of a five per cent, solution of 
papayotin, and in almost all of them there was a rapid disappearance 
of the false membrane, and simultaneous decline of the fever. The 
applications should be carefully made, every ten or fifteen minutes. It 
is very expensive. 

Potassium Bichromas is highly spoken of, gr. T V"i being given in water every half 
hour till vomiting is caused, when it is to be continued every two hours. 

Potassium Chloras is the old and tried stand-by in diphtheria. It must be given 
in large and frequent doses. 

Potassm Liquor has proved itself of the utmost value in many severe cases. It 
may be given, gtt. xx, every two or three hours, as long as any mem- 
brane is present. 

Quinim Sulphas has been advocated. 

Salicylicum Acidum is of doubtful utility. 

Sodii Benzoas. Prof. Klebs, of Prague, (Per PraJc. Arzt., Jan., 1879,) praises 
this as the best of antiseptics and an antidote to the diphtheritic poison. 
He gives to adults as much as ^ss daily, dissolved with an equal 
amount of sugar in mint-water. Others have also spoken well of it in 
smaller doses, 5j-ij daily. 

Sodium Chloridum has been used by Dr. G. F. Stewart, of Tennessee, in three 
well-marked cases, with the happiest results. 

Sodii Salicylas is recommended by Dr. C. R. Illingworth, (Lancet, 1884). To 
an adult he gives from five to ten grains with twenty minims of the 
aromatic spirits of ammonia every two hours. If the pulse should be 
feeble and rapid he adds five minim doses of digitalis, and if there 
should be any delirium, ten grain doses of bromide of potassium. 

Sulphites and Sulpho- Carbolates of Sodium, etc., have been at times extravagantly 
praised, and again wholly condemned. In some epidemics they cer- 
tainly have been efficacious. 

*Stimulants. Dr. W. Squire, of London, lays down the rule, the less the 
quantity of nourishment the patient is able to take, the greater must be 
the dependence on the stimulant. The youngest children may require 
a teaspoonful of brandy every two hours ; a child of three years of age, 
two teaspoonfuls. It may be given diluted in any way, very small 
quantities at a time, frequently repeated. Older children take it well 
mixed with ice or soda water. Champagne is often a good substitute 
for brandy. 

Thymol. The following formula has proved very efficacious in the hands of Dr. 
"Warren, (Le Pr ogres Medicale, 1882). 



182 DISEASES OF CHILDREN. 

214. R. Thymol, gr. ivss-vjss 

Potass, chlorat., 3^J SS 

Quinise bisulph., ^ss-j 

Spts. vini gallici, f.^viijss 

Glycerinse, f-S^J- M. 

For children from two to five years of age, a dessertspoonful maybe 
given every hour, or every second hour. 

Turpentine is highly recommended by German clinicians, (Jourjial de Medicine 
de Paris, 1884.) The dose for children is a coffee-spoonful morning and 
evening. It may be given to children directly after a drink of warm 
milk, or it may be mixed with the milk and then taken. It has been 
found to act with great rapidity, since within half an hour a bright red 
rim can be observed around the diphtheritic exudate, which is soon cast 
off. 

LOCAL APPLICATIONS. 

*Acid Hydrofluoric by inhalation is recommended by Henri Bergeron, of 
France. He uses { of a drachm for every 1^ cubic yard which the 
apartment contains, evaporated in the space of three hours. He claims 
that they never do harm, that all whom he submitted to this treatment 
for forty-eight hours were cured, and that it acts as a prophylactic for 
the attendants. The acid is allowed to slowly evaporate from a leaden 
vessel. 

Alcohol by inhalation is recommended by Dr. C. T. Melsheimer, of Indiana, in 
what he calls croupal diphtheria. 

Argenti Nitras. Dr. W. Squire, of London, recommends in diphtheria, when 
the whole of the false membrane is visible, and its margins within reach, 
to apply to the patch, and to the surrounding turgid mucous membrane, 
a solution of the nitrate (one pait to three of distilled water). When 
there is much redness and pain, a weaker solution (one part to eight or 
twelve of distilled water), penciled over the whole surface, tends to 
prevent further exudation and affords relief. The solid nitrate is 
objectionable. 

Blistering. Dr. F. W. Bartlett, of Buffalo, N. Y., reports, in the Therapeutic 
Gazette, 1883, one case, wherein the throat exudation markedly dim- 
inished and the general symptoms greatly improved, after the accidental 
blistering most severely of the abdomen, with hot turpentine. The 
raw belly was covered with an exudation, identical, to ordinary inspec- 
tion, with that in the throat ; and Dr. E. M. Reid reported to the Balti- 
more Academy of Medicine, 1884, several cases in which marked benefit 
and improvement in the throat symptoms followed the application of 
blisters to the chest. As soon as the membrane made its appearance on 
the blistered surface, the relief was observed. In some cases as the 
blister healed the throat symptoms reappeared ; but on the application 
of another blister and the metastasis of the membrane, the same relief 
ensued as before. 

Boracicum Acidum has been highly praised, painted over the throat and mem- 
branes in saturated solution and used as a gargle. 



I 



DIPHTHERIA. 183 

Brorninium. The inhalation of the vapor of bromine has been found of service. 

Calcis Aqua. Lime water inhalations are very useful, and as a gargle highly- 
esteemed. 

Carbolicum Acidum. Dr. C. Sedgwick recommends highly {Medical Times, 
February 27th, 1867,) the following formula : 

215. R . Acidi carbolici, tt^xx 

Acidi acetici, rr^xxx 

Mix and add gradually, 
Mellis, 

Tincturae myrrhae, aa f. % ij 

Aquam, ad. f.^j. M. 

Use as a gargle for adults ; apply by means of a sponge to the throats 
of children. 

Dr. F. C, Hortz, of New York, (Medical Record, August 1871, ) uses : 

216. R. Acidi carbolici cryst., 

Alcoholis, aa ^j 

Aquae, f . 3 v 

Tincturae iodinii, f. 5 iss. M. 

This makes a perfectly clear, transparent mixture, of a brown-red 
color, which soon, however, becomes pale yellow. This should be ap- 
plied to the diphtheritic exudation three or four times in twenty-four 
hours, by means of a camel's-hair brush. In adults it should be used 
in a diluted form (fifteen to thirty drops to a cup of water) as a fre- 
quent gargle, and for injections into the nostrils if the nose is impli- 
cated. 

Chloral is considered by Dr. R. Carney (Canada Lancet, 1880), as a specific 
in diphtheria. 

217. R. Chloral hydratis, *j 

Aquae, £j. . M. 

S. — Use as a gargle every hour or two. 

It may be applied by a sponge swab in infants. 

Eucalypti Oleum. This has been introduced as a remedy in diphtheria by Prof. 
Mosler. He adds a teaspoonful of a mixture of equal parts of the 
oil with alcohol, to the water used in a steam atomizer, and directs the 
inhalation to be kept up twenty minutes in each hour. It causes no 
irritation of the bronchi, and acts as a powerful disinfectant. 

Ferri Chloridi Tinctura, applied alone or diluted with equal parts of glycerine. 

Ferri Sulphas. The following gargle is highly recommended by Dr. De Sab- 
bata, of Venice : 

218. R. Ferri sulphatis puri, gj 

Acidi sulphurici diluti, rr^xxv 

Aquae, f-^iij. M. 

Use as a gargle, For a topical application, aquae f. gij should be 
used in the above. (Dobell's Reports, 1876.) 



184 DISEASES OF CHILDREN. 

Dr. Fera uses the finely powdered dried sulphate. He applies it 
with a horse-hair brush to the diphtheritic patches, and repeats it twice 
a day. The benefit is prompt and visible. 
Liq. Ferri Subsulphatis (Monsel's solution) is highly extolled as a local appli- 
cation, by Dr. W. M. Hepburn, of Pennsylvania, in the Medical and 
Surgical Reporter, 1884. 

Hydrargyrum Chloridum Corroswum. Dr. Tomasso Billotti has tried in a 
number of severe cases : 

219. R. Hydrarg. chlor. corrosivi, gr. j. 

Alcoholis, n\,xv 

Aquae, Tr^xx. M. 

Apply with a fine camel' s-hair brush to the diphtheritic patches, two 
to live times a clay. The application must be performed with care, 
though he never had any bad results from it. All his patients re- 
covered in one or two days. (Dobell's Beports, 1877.) 

Iodinium. Dr. Waring-Ourran obtains excellent results from iodine inhala- 
tions : 

220. R. Potassii iodidi, 

Iodinii, aa gr. iv 

Alcoholis, f. % iv 

Aquae, f.^ iv. M. 

A teaspoonful (gradually increased to a tablespoonful) of the solu- 
tion, is to be placed, with a handful of dried garden sage, in a pint 
of boiling vinegar, in a common inhaling jar, for inhalation. The 
inhalations are to be repeated about twelve times daily. 

* Iodoform is very highly praised by a number of authorities. 

*Lacticum Acidum. Lactic acid inhalations, by means of a spray producer (1.5 
to 20 gtt., aquae f. % ss,) are said to act as a powerful solvent of the false 
membrane. 

Limonum Succus is strongly recommended as a gargle. 

*Muriaticum Acidum. Dr. Hillier prefers this caustic to nitrate of silver. In 
very dilute solution, it is an excellent gargle. 

Potassii Chloras in strong solution is an excellent gargle. 

Potassii Permanganas. Dr. Watson Campbell recommends {Edinburgh Medi- 
cal Journal, February, 18G7,) the following : 

221. H. Potassii permanganatis, gr. x 

Aquae, f.gxx. jy[. 

To be used as a gargle, together with the internal administration of 
iron and port wine. 

Pepsin. Acid glycerine of pepsine is recommended by Dr. W. Hale White, 
{Lancet, 1882), as a solvent for diphtheritic membraue, used as a spray. 

Salicylicum Acidum. For those who can gargle, Dr. Wagner, of Fribourg, re- 
commends the following formula : 



DIPHTHERIA. 185 

222. B . Salicylic acid, 150 parts. 

Alcohol, 15 " 

Distilled water, 150 " M. 

To be used every two hours. 

He reports fifteeen serious cases as being cured by this method. For 
children too young to gargle, he gives the acid in water or wine, in 
doses of 1^ to 4f grains every two hours. 

Sassafras, oil of, is praised as a local application, by Dr. Kennard, of St. 
Louis. 

Sodce Chlorinata Liquor, used as a disinfectant gargle. 

* Sodii Hyposulphis. Dr. Maynard recommends {Medical Times and Gazette, 
December 30th, 1865, ) the local application of the hyposulphite of soda. 
In the very early stages he employs, two or three times a day, the fol- 
lowing lotion : 

223. R. Sodii hyposulphitis, 31J 

Glycerinae, f. g ij 

Aquae, f-3 v J- M. 

This, he finds, generally removes the incipient exudation in forty- 
eight hours, or less. In advanced stages he washes the throat out 
well with warm water by means of a flexible syringe, and then 
dresses the affected part with the above solution, using at the same 
time the following gargle : 

224. R . Sodii hyposulphitis, Z j 

Glycerinse, 3.j 

Aquae, Oj. M. 

The effect of this solution he asserts to be most marked ; it appears 
to solidify and dry up the false membrane, and when the syringe is 
again used, which it should be frequently, the force of the water will 
wholly or partially wash it away. The exudation rarely re-forms, and 
the patient makes a comparatively rapid recovery. It is also highly 
recommended by Dr. J. M. xIrmstrong, of Lisbon, Iowa, who uses it 
in connection with quinine and whisky and insufflations of sulphur, 
{Medical and Surgical Reporter, 1881). Dr. M. Meredith, of Vinton, 
Iowa, (Ibid.) has also used the hyposulphite of soda in diphtheria, and 
thinks it a valuable remedy, but he prefers : 

225. H . Potass, chloratis, . g j 

Acidi hydrochlorici, TT^xv 

Ext. belladonnae n\, n\,xv 

Aquae, f-5 iv - ^L 

S. — f.gss to an adult every two hours. 

Sulphur. The insufflation of sublimed sulphur was first recommended by Dr. 
Barbosa. (Practitioner, November, 1868.) The unwashed flower of 
sulphur should be applied, by means of a simple tube slightly bent, 
directly to the affected surfaces. Reports of its utility are conflicting. 
It is also recommended by Dr. R. Wood, in the North Carolina Medical 



186 DISEASES OF CHILDREN. 

Journal, 1879. He mixes it with flaxseed water and uses by mopping, 
gaigling, or injecting through the nasal passages, or what is preferable 
when it can be done, blowing the dry sulphur through a reed or quill 
directly on the diseased surfaces, and lastly by fumigation. 
Terebinthinm Oleum. Dr. Symonds advises {British Medical Journal, March 
14th, 1868,) the application of turpentine at the very commencement. 
Hot turpentine epithems also often relieve the local distress. Dr. 
Taube uses turpentine inhalations, 15 to 20 drops of the oil in hot 
water, hourly. 



ECZEMA. 



DR. EDWARD HENOCH, OF BERLIN. 

The question arises whether the disease should be rapidly cured. He 
makes it a rule not to cure at once chronic eczema which has lasted for 
many months or even years, especially on the face or scalp. He ap- 
plies local treatment to one part of the diseased skin after another, a 
plan to which we are forced, in many cases, by the great extent of the 
disease. The crusts should be first removed by inunctions with vase- 
line or fresh oil, or fomentations of lukewarm water (the latter being 
preferable on the scalp). After the removal of the crusts, the red and 
moist skin is washed once a day with soap-water (sapo viridis) and 
then bandaged with unguent. Hebrge, which should be applied for 
twelve hours. When the inflammation is severe, he first orders fomen- 
tations of lead- wash. The most difficult part of the procedure is to 
fasten the bandage to the face in little children, and prevent scratching. 
The former is best effected by the application of a linen mask, upon the 
inner surface of which the ointment is smeared, and the latter by en- 
veloping the hands and fingers with cotton and linen. Instead of 
Hebra's lead ointment, he has also used successfully ointments of 
salicylic acid. 

226. R. Acid, salicylic, gr. xlv-^j 

Spts. vini, 

Glycerini puri., aa q. s. 

Vaselini, 3vij. M. 

S. — To be used as an ointment. 

Or tannin. 

227. R . Acid, tannici, gr. xxx 

Vaselini, Jvij. M. 

S. — To be used as an ointment. 



ECZEMA. 187 

Or zinc : More rarely and only in eczema of small extent, he uses an 
ointment of hydrarg. alb. or rubr. It is not advisable to use tar oint- 
ments from the beginning, as they may prove too irritating and increase 
the inflammation ; on the other hand, they should be recommended 
after previous treatment with the ointments mentioned above, in order 
to make recovery more lasting. He generally uses oil of cade, which 
is applied daily as a liniment (1 part to 2 or 3 parts olive oil), after 
previously soaping the diseased parts. But, in applying tar ointments 
to extensive surfaces, you must always bear in mind the possibility of 
an irritant action on the kidneys, and therefore carefully examine the 
urine, the blackish color of which or the presence of albumen at once 
requires a discontinuance of the treatment. The duration of the treat- 
ment naturally varies greatly. While many eczemas, even those which 
have lasted for a long time, recover in a few weeks, others require 
treatment for months, and even then we often find that relapses occur 
without any ascertainable cause. In these very obstinate cases he has 
sometimes derived good results from the use of arsenic, in the form of 
Fowler's solution. Even children only two or three years old tolerate 
the remedy excellently in small doses (3 to 5 drops of the mixture t. 
i. d. given on a full stomach). In the scrofulous diathesis he has had 
good results from the use of the syrup of the iodide of iron or a mix- 
ture of iodine and iodide of potash. He does not recommend salt 
baths, as they not infrequently render the eruption worse by irritating 
the skin too severely. He would rather advise lukewarm (26° R.) 
soap or sulphur baths. 

DE. W. H. PARISH, OF PHILADELPHIA. 

The scabs must be removed as fast as they form {Medical and Sur- 
gical Reporter , 1884), and this can best be done by the aid of a 
starch poultice ; when you remove it, the scabs will come with it. To 
the raw surface, apply benzoated oxide of zinc ointment; if there is 
much cutaneous irritation, dilute the ointment with one-fourth vaseline. 
For chronic cases, he uses an iodide of lead ointment, ten grains to one 
ounce of cocoa butter. Internally, he gives Fowler's solution, one- 
half drop three times a day to a child aged seven months. 

M. LASEAE, OF FRANCE. 

This author {Medical and Surgical Reporter, 1883,) highly rec- 
ommends the following prescription in the form of eczema capitis 
observed in very young children. 



188 DISEASES OF CHILDREN. 

228. R . Acid salicylic, 3 ss 

Tinct. benzoin, f. 3 j 

Ung. petrolei, ^iij. M. 

The child's head should be first thoroughly washed with castile soap, 
and then carefully anointed three times daily with the ointment. If 
the crusts are hard and difficult to remove, they may be softened with 
olive oil, containing two per cent, of salicylic acid. 

DR. R. W. WILCOX, OF MISSOURI. 

Many cases, in children, fail to improve, according to this physician, 
because the applications are not closely applied to the diseased surface. 
To remedy this difficulty {St. Louis Medical and Surgical Journal, 
1882), he uses a piece of cloth, with holes for the nose, mouth and 
eyes, and with slits for the ears to assist in keeping it in position. The 
ointment should be thickly smeared over the mask, which is to be worn 
constantly, only being removed as lotions are being applied. This 
treatment effectually prevents the scratching, which so thoroughly 
thwarts all endeavors. Any ointment can be used, but, for the most 
part, diachylon, very carefully made, is selected. In the same way, a 
skull-cap can be made for eczemas of the head. 

PROFESSOR LOUIS A. DUHRING, OF PHILADELPHIA. 

The treatment is in some cases easy, and in others not so. It is 
hard to predict, in any given case, what its course will be. Where the 
general health is good, no internal treatment is indicated. A not very 
stimulating local treatment is then needed. He uses, in such cases, an 
ointment of boracic acid, a drachm to the ounce of vaseline, to be 
rubbed in three times a day ; the parts to be previously washed with a 
lotion containing three drachms of boracic acid to the pint of water. 
If this treatment does not produce beneficial results in a week, he sub- 
stitutes an ointment composed of equal parts of tar ointment and vase- 
line. {Medical and Surgical Reporter, 1882). 

M. VIDAL, OF PARIS. 

In eczema of the scalp, accompanied by impetigo, this author 
(Progres Medical, 1881,) employs the following treatment. Lotions 
with decoction of walnut leaves. Frictions morning and evening with 

229. R. Glycerit. amyli, 3J. 

01. cadini, Zib M - 






ECZEMA. 189 

Suspend the frictions if they prove too irritating. As general treat- 
ment, he uses iodide of iron, the vegetable bitters, and sulphur baths, 
if the constitution be enfeebled, as it is in the generality of such cases. 
In another very different form of the disease, M. Yidal employs the 
following : 

230. .& . Glycerite amyli, gj. 

Tannin, 3 ss. 

Hydrarg. submuriat., gr. xv. M. 

The above formulae are proportioned for adults. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

It is necessary to remove the constitutional disturbance which may 
be the essential cause of the affection, to allay the local distress, and to 
promote the healthy, vigorous nutrition of the skin. The most rapid 
and certain cures can only be effected by a judicious combination of 
general and local remedies. In mild cases, which show but little dis- 
position to extend and are not attended by much irritation, regulation 
of the child's diet, and the use of simple bland applications, will be suf- 
ficient. When the disease is more extensive and attended with much 
irritation, it is necessary to examine carefully into the state of the di- 
gestive function, and if this be in any way disordered, to endeavor to 
restore it to a more healthful condition. When the child is teething, 
the gums ought to be examined, and, if found swollen or inflamed, they 
should be lanced as often as is necessary. 

Constipation, if it be present, must be overcome by altering the 
diet, or by the administration of rhubarb, small doses of magnesia, 
Rochelle salts, or sulphur. If there are any evidences of acidity of 
the stomach, it is well to employ some of the various preparations of 
the alkalies. So also when diarrhoea is present, it should be treated by 
attention to the diet ; and by the administration of a weak castor-oil 
emulsion, containing small quantities of laudanum, when the stools are 
feculent, but small, frequent, and attended with griping; when they are 
thin and watery, greenish, and composed in part of mucus, the follow- 
ing prescription will often prove very useful : 

231. R . Tr. kramerise, f. 3 j. 

Tr. opii, gtt. vj. 

Sodii bicarb., J)j. 

Syr. zingiberis, f-Jvij. 

Aquae, f.jfij. m. 

S. — Teaspoonful two or three times a day, for children of one and two 
years old. 



190 DISEASES OF CHILDREN. 

In chronic eczema, arsenic is the most useful remedy ; it is essential, 
however, that there shall be no undue irritability of the gastro-intestinal 
mucous membrane, or it will inevitably disagree. The following for- 
mula is recommended : 

232. R . Liq. potassii arsenitis, tt^xvj ad xxxij 
Vin. ferri amari., 

Syr. tolutani, aa f. ,^j 

Aq. carui, f-5ij- M. 

S. — Teaspoonful tbrice daily, directly after food, for an infant from six 
months to a year old. 

Its use should be immediately suspended, upon the supervention of 
any disturbances of digestion. The ptvffiness of the eyelids, one of the 
earliest and most characteristic symptoms of the physiological action of 
arsenic, is of no alarming importance, and the remedy need not be im- 
mediately suspended on account of its occurrence ; though it is more 
prudent to reduce the dose and frequency of administration, and to 
watch carefully for any further signs of over-action of the drug. In 
cases that prove rebellious to local treatment and the use of arsenic, 
cod-liver oil acts well. In cases where there is marked anaemia and 
debility of constitution, the syrup of the iodide of iron has produced 
good results. This may be given in combination with the compound 
syrup of sarsaparilla, in the dose of from gtt. ij to gtt. v of the former, 
diffused in from a quarter to a half teaspoonful of the latter, three times 
a day, for children of one or two years of age. Where the tongue is 
heavily coated and the bowels constipated, with whitish or clay- 
colored stools, minute doses of blue pill or calomel, in combination with 
bicarbonate of soda, may be given from time to time, with manifest 
advantage. 

Local Treatment. — All possible sources of local irritation must be 
removed. Whenever crusts or scales cover the affected surfaces, they 
should be removed very gently, by first softening or loosening them by 
oily applications or poultices, and then by using tepid water with or 
without soap. In the acute stage, great relief may often be obtained 
by the use of compresses repeatedly wet with water, either cool or hot, 
or with some emollient decoction, as of marshmallow, poppy heads, 
bran or flaxseed, sassafras pith or slippery elm bark. Weak lotions, as 
of one drachm of bicarbonate of soda, or of half a drachm of borax 
with a little morphia to a pint of water, or of diluted lead-water or 
carbolic acid J to 1 drachm to a pint of water, may be found more 



ECZEMA. 191 

soothing in other cases. The surface may be powdered from time to 
time with finely-powdered lycopodium, carbonate of zinc, or with the 
following : 

233. R. Pulv.amyli, ^vj 

Pulv. zinci oxidi, 5 SS_ 3J 

Pulv. camphorae, gr. xv. M. 

When ointments are preferred, we may use : 

234. R • Pulv. camphorse, ,►} j 

Pulv. zinci oxidi, 3*j 

Glycerinse, f. gss 

Adipis benzoat., 3 V J« 
M. et. ft. ung. 

When the patches of eruption are small, our authors have success- 
fully used ointment containing murcury ; using one part of ung. 
hydrarg. nitratis to three or four parts of simple cerate or cosmoline. 
The following ointments are also recommended : 

235. R . Hydrargyri protiodidi, gr. xij 

Camphorse, gr. v 

Axungise, 3J. 

M. and ft. ung. S. — Apply twice daily. 

Or, 

236. R . Hydrargyri chloridi mitis, 9 j 

Camphorse, . gr. v 

Glycerinse, f. 3 j 

Ung. aquae "rosse, ^j. M. 

Ft. ung., 

Or we may use weak solutions of bichloride of mercury, as Van 
Swieten's liquor : 

237. R. Hydrarg. chlor. corros., gr. xviij 

Alcoholis, f. 5iij 

Aquae destillat., f.^xxiv. M. 

Ft. sol., 

In chronic eczema, we may use : 

238. R. Oleicadini, f.^ss-f. 3J 

Cerati simplicis, ^j 

01. amygdal. amar., gtt. v. M. 

Ft. Ung., 

In chronic cases, when the patches of disease are circumscribed, we 
may use : 



192 DISEASES OF CHILDREN. 

239. R. Picis liquidse, f. gij 

Potassse causticse, ^j 

Aq. destillatse, f.^v. M. 
S. — "Liq. picis alkalinus." 

To be used very largely diluted with water, as from one fluid drachm to 
the pint up to one part in ten of water, according to the extent of the 
disease and the susceptibility of the surface. 



EPHEMERAL FEVER. 

DR. R. L. MOORE, OF MINNESOTA, 



uses: 



240. R . Tinct. aconite, (German) gtt. xv 

Aquae, f. g iij. M. 

S. — Teaspoonful every half hour, with plenty of cold water, and sponging 
the whole body often. 



ERYSIPELAS NEONATORUM. 

DR. JOHN FERGUSON, OF TORONTO. 

In the American Journal of Obstetrics, 1884, this author records 
a case of universal erysipelas in a child aged ten months, that re- 
covered under the following treatment. 

The local treatment consisted in frequently and thoroughly anointing 
the skin with the following : 

241. R. Acid, carbolici, gr. v 

Ext. belladonna, gr. xv 

Ung. petrolei, « Jj. M. 

Soft cloths were kept next the skin, and the child loosely and comfort- 
ably covered. 

The internal treatment consisted in the administration of one tea- 
spoonful every three hours, in water, of: 

242. R. Quin. sulph., gr. iv 

Acid, hydrochlor. dil., n^xxxij 

Tr. ferri chloridi, f. £ iss 

Glycerini, 3 iv 

Syr. simp., ad ^ij. M. 



EPHEMERAL FEVER. 193 

As the child was nursing, no other form of food of any kind was 
given, nor alcoholic stimulants. 

The duration of the attack, from its commencement at the vulva to its 
disappearance at the eyes and mouth, was fifteen days. 



Our authors prefer the use of cooling emollient applications during 
the first part of the attack, whilst the skin is of a bright red color, hot 
and shining. When the circulation becomes languid, and the color of 
the eruption is disposed to deepen from red to purple, we should sus- 
pend the use of the emollient applications, and employ instead the lotion 
of camphorated spirit, recommended by Underwood ; the camphorated 
tincture of soap, applied three or four times a day with a soft sponge, or 
Kentish's ointment, prepared by rendering basilicon ointment soft (not 
fluid) with spirit of turpentine. It is rubbed upon the inflamed part 
with the fingers, the anointing being " repeated often enough to keep 
the part always very thinly covered." The internal treatment should 
consist in attention to the bowels, which are to be kept soluble by the 
mildest laxatives, without being purged, and in a resort to tonic and 
stimulating remedies upon the very first approach of symptoms indicat- 
ing exhaustion. The best remedies of this class are proper diet, wine 
whey, small quantities of brandy and bark, in connection with minute 
doses of carbonate of ammonia. In addition to these, the tincture of the 
chloride of iron should be given in large doses. For an infant of a 
month old we may use, 



M. 



When the inflammation has gone on to the production of subcutaneous 
suppuration, it becomes still more important to sustain the forces of the 
constitution, by giving the baby a healthy and abundant breast of milk, 
and by the internal use of brandy in small quantities, of bark, or better still, 
of quinia in combination with small doses of carbonate of ammonia. At 
the same time, the suppurating surfaces must be well fomented, and dressed 
with warm poultices, and when necessary laid open by careful incisions, 
observing the precaution to cause as small a loss of blood as possible. 
13 



243. R. Tinct. ferri chlor., 


f.3ss 


Acid, acetici dil., 


f.gss 


Liq. ammonise acetat., 


f.3J 


Syr. simpl., 


f. % ss 


Aquae, 


q. s. adf.^iij. 


S. — Teaspoonful every three hours. 





194 DISEASES OF CHILDREN. 

DR. EDWARD HENOCH, OF BERLIN. 

Treatment is almost entirely unavailing in this affection. In the be- 
ginning, we may attempt to ameliorate the inflammatory process by 
large fomentations of lead water. Internal remedies, aside from mild 
purgatives, are entirely useless. If the erysipelas begins to extend, 
there is no remedy that will check its spread. Nothing remains but 
the use of tonic remedies, wine and infusion of bark. Complications 
must be treated according to their character. Abscesses must be poul- 
ticed, opened when distinct fluctuation is felt, and antiseptic dressings 
employed. 



ERYTHEMA. 



DR. LORENZO, OF ITALY. 

This author (Archivio di JPatologia, 1884), considers that erythema 
is one of the simplest and earliest to occur of the non-contagious inflam- 
mations of the skin. The author has seen 400 cases. The disease is 
caused by the contact of irritating substances, fteces, urine, etc., with 
a very tender skin, together with the natural heat of the affected parts. 
When due to syphilis, we may expect to find enlarged glands or oezena, 
or both, which are, of course, absent in simple erythema. The treat- 
ment, in simple cases, in addition to suitable hygienic and dietetic 
measures, is not elaborate, since it may be limited to dusting the in- 
flamed surface with starch, lycopodium or some other unirritating 
powder. If considerable irritation exists, a solution of the acetate or 
bicarbonate of soda (saturated or even weaker) may be applied. Baths 
should be infrequent, but, in their stead, applications may be made to 
the skin with sambuco water, laurel water, a mixed solution of 
Goulard's extract, a solution of bicarbonate of soda, or one of chlorate 
of potassa in the strength of fifteen grains to four ounces of water. In 
cases in which the hyperesthesia is very annoying, small doses of 
bromide of sodium may be given by the mouth. In addition to the ap- 
plications already mentioned, the author suggests as useful, a liniment 
made of oleate of zinc, glycerole of starch, or Wilson's benzoated oint- 
ment, either alone or combined with bismuth. In cases in which 
eczema is a complicating condition, he recommends green soap combined 
with oxide of zinc. 



HEMATOMA OF THE STERNO-MASTOID. —HEAD ACHES. 195 



HEMATOMA OF THE STERNO-MASTOID. 

DR. EDWARD HENOCH, OF BERLIN. 

According to this author's observation, the swelling always takes a 
favorable course, becomes gradually smaller, and finally leaves a more 
or less firm cicatrix in the muscle, which interferes very little or not 
at all with its functions. He has never seen ulceration. The natural 
process of recovery by the formation of a cicatrix renders treatment 
unnecessary. At the most, an ointment of iodide of potassium may be 
rubbed over the tumor as a placebo, or in order to help the case under 
observation. 



HEADACHES 



DR. DAY, OF LONDON. 

This author calls attention (Lancet, 1883,) to neuralgia or one- 
sided headache, which, he says, is more common in children than is 
generally supposed. This headache may be due to dental caries or to 
foul air. Dr. Mackenzie insists upon the importance of careful exam- 
ination of the eyes in cases of headache of children, as myopia may 
produce it. Ear disease is also sometimes a cause. In all cases, 
therefore, of headache in children, it is important to examine the ear 
and the eye, using the ophthalmoscope, which will be of great import- 
ance in detecting organic disease. 

DR. TREICHLER. 

This author calls attention (Medical and Surgical Reporter, 1880,) 
to the fact that one-third of the pupils in schools suffer more or less 
from headache. It leads to poorness of blood, and loss of cheerfulness 
and mental energy. Its chief cause is overwork and nocturnal study. 
The remedy is obvious. 



196 DISEASES OF CHILDREN. 

HYDROCEPHALUS. 

DR. EDWARD HENOCH, OF BERLIN. 

According to this author, the treatment in the beginning of the affec- 
tion should consist of local bleeding, by means of a few leeches ap- 
plied behind the ears or upon the forehead, ice-fomentations to the 
head, and purgatives, preferably calomel (gr. J-J a few times a day). 
At a later period, when the inflammatory stage has passed and we wish 
to initiate the absorption of the fluid, he recommends the continued 
use of mercurials in small doses, inunctions of unguent, cinerit. on the 
head and neck, (15 grs. every day), and a blister to the neck, to the 
application of which great fear is now unjustly entertained. But the 
antiphlogistic method is applicable only in those cases in which the 
primary inflammatory stage has either been directly observed, or can, 
at least, be proven to have been present. He always regards internal 
chronic hydrocephalus as incurable, as soon as the head has increased 
in size to any considerable extent. He has achieved no results what- 
ever, either with mercurial inunctions, iodide of potassium, or applica- 
tion of tincture of iodine to the head, nor from compression of the 
skull with adhesive strips, or from puncture through the fontanelles. 
When these methods of treatment have proven successful (this has 
happened in very rare cases) the case must have been one of external 
hydrocephalus. 

DR. ARMAND SEMPLE, OF LONDON. 

If the child be robust, it may be placed in a warm bath, a few 
leeches may be applied to tke temples, or the ice-bag and cold evaporat- 
ing lotions to the scalp ; in every case light and sound should be ex- 
cluded, and one grain of calomel mixed with a little sugar should be 
placed on the tongue every three or four hours ; saline aperients, as tar- 
trate of potash, may also be given combined with syrup of senna. 
When effusion comes on, iodide of potassium may be employed with 
advantage, followed by the administration of the syrup of the iodide of 
iron and cod-liver oil. 

DR. HUGH P. DUNN, OF ENGLAND. 

In the Lancet, 1882, Dr. Hugh P. Dunn recommends paracentesis 
in cases of hydrocephalus, believing that when the operation is properly 



HYDROCEPHALUS. 197 

performed it is not dangerous, but on the contrary, is productive of 
much good. A small aspirator, of about half an ounce capacity, fur- 
nished with a double cock arrangement, is the instrument he uses. 
The child being held on the nurse's lap, with its head facing the light, 
the operator marks a point in the situation of the coronal suture about 
an inch from the longitudinal sinus, and holding the needle firmly in 
his right hand, thrusts it into the cranium with its point slightly inclined 
inward. It is a good plan to first thoroughly cleanse the needle in a 
solution of carbolic acid. The needle having entered the cranium, the 
surgeon grasps it close to the scalp by the forefinger and thumb of the 
left hand and steadies the head with the right, and the assistant manip- 
ulates the piston of the aspirator. The piston should be slowly with- 
drawn, and pauses of a few seconds now and again allowed to elapse, 
in a manner similar to the application of the ecraseur. The position 
of the needle may be altered from time to time, according as the ten- 
sion on the piston shows that the fluid has diminished. After about 
half an ounce of fluid has been abstracted, compression of the cranium 
should be secured. The best way to secure this is to use a piece of India- 
rubber tubing, corresponding in diameter to a quarter-inch gas pipe. 
The tube, around which some lint may be wrapped or sewed, should be 
made to encircle the cranium twice, at a level with the pccipital pro- 
tuberance behind and the centre of the forehead in front. As the fluid 
is gradually withdrawn, the tube is, from time to time, readjusted and 
tightened. When the operation is completed, the punctured spot is 
covered with a piece of dry lint, and attention directed to compression 
of the cranium, which can be accomplished by fixing the tube in situ, 
or a capeline bandage of flannel carefully applied. 

PROFESSOR S. D. GROSS, OF PHILADELPHIA. 

This distinguished authority (jSledical and Surgical Reporter, 
1881,) considers that very little can be done for the relief of this con- 
dition. The late Dr. Conquest, of England, published a series of cases, 
in all about fifteen or eighteen, where a cure followed the operation of 
tapping. Dr. Gross places no reliance on his statements, for the ex- 
perience of the entire medical and surgical profession is against his con- 
clusions. Due attention to hygiene is, in the opinion of Dr. Gross, 
about all that can be recommended for these patients. 



198 DISEASES OF CHILDREN. 

C. WEST, M. D. 

The value of purgatives can scarcely be overrated in acute hydro- 
cephalus, but they must be given so as not merely to obtain free action of 
the bowels, but to maintain it for some days. This end is best secured, 
after having once overcome the constipation, by giving small doses of a 
purgative every five or six hours. The administration of strong cathar- 
tics every morning will not answer the end nearly so well ; if they cause 
sickness, it is better to give a single full dose of calomel, and follow it 
up with sulphate of magnesia at short intervals. The following mixture 
is then advised : 

244. R. Magnesise sulphatis, gj 

Potassii nitratis, gr. x 

Syrupi limonis, f. % iij 

Aquae, f. gix. M. 

A dessertspoonful (f. gij) thrice daily, for a child of one year. 

In all cases, of course, the solution and regulation of the purgatives 
must be determined by the strength of the child. 

The local abstraction of blood by leeches sometimes proves service- 
able when there is much febrile action. They should be placed on the 
crown of the head rather than on the temples. They are inadmissible 
when the patient is much debilitated. 

J. S. RAMS KILL, M. D. 

The iodide of iron is usually w r ell borne by hydrocephalic children, 
unless there be a tendency to congestion or inflammatory action. 
Among the children of the poor, the combination of cod-liver oil and 
syrup of the iodide almost always gives satisfactory results. 

The mercurial plan of treatment advised by Prof. Golis, of Vienna, 
is regarded by Dr. Ramskill as one of the best. The head should be 
shaved, and the following ointment prescribed : 

245. R . Unguenti hydrargyri, gr. xx-xl 

Unguenti olei juniperis, §j. M. 

To be rubbed on the shaved scalp, twice a day. 

The child should wear a woolen cap, to prevent the risk of the per- 
spiration being checked by the cold air. Calomel (gr. J— ss) should be 
given thrice daily. If this purges too much, the mercurial inunction 
should be alone employed. The treatment is to be persevered in for 
thirty or forty days, when, if there be some improvement, the remedies 



HYDROCEPHALUS. 199 

may be gradually diminished, but the cap is to be worn after the in- 
unction has been discontinued. If there be no marked improvement 
after six or eight weeks, some diuretic, as acetate of potash, or squill, 
may be added, and a couple of issues may be inserted in the occiput. 
Blisters to the nape of the neck may be advantageously substituted for 
these. Whenever there is heat of head, and the child grows fretful, 
restless and irritable, a couple of leeches behind the ears will be found 
of service. When convalescence has begun, it may be accelerated by 
small doses of quinine. 



This writer has reported remarkable success in several cases ,of 
chronic hydrocephalus, by the external use of pure glycerine. {Trans- 
actions of the Ohio Medical Society, 1876.) He gives, for instance, 
the case of a child, eighteen months old ; head, twenty-four inches in 
circumference ; sutures separated, and bulging of integuments. He 
applied twice daily to the head glycerine, with a little tincture of iodine, 
and directed the use of a close-fitting cap. The application caused the 
child " to sweat dreadfully." This suggested that glycerine, because 
of its strong affinity for water, had caused an exudation of serum, 
which, if continued, might cure the child — a hope strengthened by re- 
membering the drain following its application to indurations of the 
uterus. After a year's use, the child was cured. In 1874, the child 
w r as attending school, with fair intellect and good health. 

Dr. Mervel, of Monroe ville, Ohio, has reported the result of a 
partial trial in one case. Child under one year old ; head circumfer- 
ence, twenty-two inches ; eyes much protruded, as well as integuments 
over separated sutures. Applications of glycerine were followed by 
profuse serous flow. In three weeks the eyes were restored to their 
natural position, and there was no protrusion between cranial satures ; 
but the head was not reduced in size. 

PROF. ELLERSLIE WALLACE, M. D., PHILADELPHIA. 

The following is one of the best tonics which can be given in this 
disease : 

246. R. Potassii iodidi, J}j 

Syrupi tolutani, f.£ss 

Aquae, f.'^ij. 

A teaspoonful morning and evening, after food. 



200 DISEASES OF CHILDREN. 

In some cases, the elix. quinice, ferri et strychnice, acts in a most 
satisfactory manner. 

DR. NATHAN S. DAVIS, CHICAGO. 

The method in chronic hydrocephalus proposed by Prof. Brainard, 
of puncturing the head and injecting a weak solution of iodine and 
iodide of potassium, has been tried, but no successful case has been 
reported. The objects toward which the medical treatment must be 
directed, are, first, to allay the morbid excitement of the cerebral 
structures ; and, second, to exert a gentle, yet persistent alterative and 
diuretic influence, avoiding, carefully, any impairment of the digestive 
organs. Dr. Davis has succeeded in accomplishing these purposes by 
the following prescription: 

247. R . Extracti fluidi Scutellariae, f. % ij 

Tincturae digitalis, f. % ss 

Potassii iodidi, ^ij 

Extracti Audi hyoscyami, f.gss. M. 

Twenty drops, four times a day, in sweetened water. 

If the digitalis is found to be exerting too much influence, the dose 
must be diminished. Mercurials are of no advantage in the chronic 
stage ; though, in the early inflammatory stage, combined with mild 
laxatives, they might check the progress of the disease. 

NOTES ON REMEDIES. 

Anlimonii et Potassce Tartras is now much less employed than formerly, being 
considered less efficacious than cod-liver oil, iodine, and nutritives. 

Hydrargyri CMoridum Corrosivum has been given in doses gr. ^ to yV, with 
good results, but calomel is generally preferred, when mercury at all is 
given. The mercurial treatment of acute hydrocephalus, once so gen- 
eral, is now rarely resorted to, and is regarded as of little value, if not 
actually hurtful. In chronic hydrocephalus, it is however, still em- 
ployed. 

Magnesii Carbonas has been advised in doses of 5 j — ij, saturated with lemon- 
juice, taken every two or three hours, as a purgative, which sets well 
on the stomach, even when very irritable. 

Potassii Iodidum is recommended by Dr. Hillier, gr. j every four hours, for 
young children, when the disease is declared, together with ice or cold 
lotions to the head, mercurial aperients and absolute rest in a quiet, 
darkened room. 

Terebintliinai Oleurn\& recommended by Dr. Copland in incipient hydrocephalus, 
in doses of tt^v-x, with TT^xx-xl of castor oil. He also speaks highly 
of turpentine enemata. 



HYDROCEPHALUS (SPURIOUS). 201 

* Cathartics have a high value in cases of acute hydrocephalus. 

Leeches to the crown of the head are of service when there is much febrile 
action, if the patient be not too much debilitated. 

EXTERNAL REMEDIES. 

Groton Oil counter-irritation to the shaven scalp, has been recommended by Dr. 
R. S. Turner. (Edinburgh Medical Journal, November, 1868.) He 
uses the following liniment : 

248. R . Olei tiglii, . 1 part 

Olei olivse, 3 parts. M. 

* Hydrargyrum. Mercurial inunction is recommended by Prof. Golis and Dr. 

Rams kill. 
Iodine lotions to the scalp, or inunction of iodine ointment, used conjointly with 

iodide of iron and cod-liver oil, internally, offer a chance of success in 

the advanced stage. 
Iodoform inunctions of the scalp have been praised by Dr. Moleschott, of 

Turin. 

Ipecacuanha. The following counter-irritation is said to have produced great 
amelioration of the symptoms : 

249. R . Pulveris ipecacuanhas, 3 ij 

Olei olivse, f. 3 ij 

Adipis. 3 ss. M. 

To be rubbed on freely for fifteen or twenty minutes, thrice daily, 
and the parts then enveloped in flannel. In thirty or thirty-six 
hours, an eruption appears, which remains out for three or four 
days . 



HYDROCEPHALUS (SPURIOUS). 

DR. JOHN STRAHAN, OF ENGLAND. 

The hydrencephaloid condition, or spurious hydrocephalus, is liable 
to develop as a sequel of badly- treated cholera infantum ; and in order 
to call attention to this subject, Dr. John Strahan read a paper before 
the British Medical Association, 1884. 

When spurious hydrocephalus is coming on, all fever which existed 
previously in cholera infantum disappears, and the temperature becomes 
subnormal. There are irritability and fretfulness, with hoarse cry. 

Then comes on the somnolent stage. The surface is cool, the skin 
pale, the pulse quick and weak, the eyes half closed, sunken, and sur- 
rounded by wide dark circles ; the fontanelle, if still unclosed, is con- 



202 DISEASES OF CHILDREN. 

cave, the head cool. The child ceases to take notice, the pupil is insen- 
sitive to light, the head is rolled frequently from side to side, the child 
gradually becomes more drowsy. If the case be neglected or im- 
properly treated, coma gradually comes on, then convulsions and death. 

As to the treatment of the hydrencephaloid condition, should it un- 
fortunately set in, the diarrhoea, if still present, must be stopped at 
once, if possible. But whether diarrhoea be present or not, the child 
should have a hot poultice, faced with mustard, applied to the nape of 
the neck, also some very hot application to the cardiac region, on ac- 
count of the powerfully stimulant effect of local heat on the heart. He 
then gives about ten minims of aromatic spirits of ammonia in camphor- 
mixture every two hours, and, at a different time, a drop or two, accord- 
ing to age, of Ashburton Thompson's tincture of phosphorus in a little 
mucilage. If the digestion will permit it, good milk for food, not less 
than a pint and a half, or more than two pints in twenty-four hours, 
with frequent doses of ten to twenty minims of brandy. Should the 
digestion not permit of milk, then the raw-meat plan finds its most use- 
ful application. 

The nurse should be cautioned against raising the child into the up- 
right position ; the body-heat must be kept up by some means, or the 
child will die ; plenty of hot flannels and a heated room usually are 
best, but the ventilation of the room should be very good. By such 
means, a wonderful improvement is often obvious in one or two days, 
and frequently recovery is complete at the end of three days. Should 
the hydrencephaloid condition come on without previous cholera or 
diarrhoea, as it sometimes doses after weaning, from loss of blood, e. g., 
by leeches, from improper use of cathartics, or, indeed, from exhaus- 
tion from any cause, even from improper treatment of the early stages 
of the complaint itself, the treatment is just the same ; and whenever 
we see the surface of the fontanelle concave and depressed, we should 
put thoughts of cerebral congestion and tubercular meningitis out of 
our heads, and diligently employ every means of tone-giving, stimula- 
tion, and support. 



HYSTERIA. 203 



HYSTERIA. 



PROFESSOR F. FORCHHEIMER, OF OHIO. 

According to this author (Archives of Pediatries, 1884,) hysteria 
in children has received altogether too little attention. From his ex- 
perience he believes, that in nearly all cases of severe hysteria, the 
inception took place during childhood, and that fully one-half of all 
cases show nervous symptoms long before puberty. The hereditary 
factor plays a very important role in the production of this disease, 
therefore with children of neurophathic parents, we should aim to develop 
their bodies as much as possible, even, if need be, to the neglect of their 
minds. For this purpose, gymnastics of all sorts are advisable ; riding, 
swimming, if the child be old enough ; in younger children, massage, 
beating and rubbing of the muscles, and cold sponge-baths, are very 
effectual. The child must be allowed to go out of doors ; if unwilling, 
it must be compelled to do so with its attendant. If possible the child 
should be removed from the influence of its nervous parent. If neces- 
sary to send such a child to school, the ideal school will be one in 
which there are a great many pupils, but the hours very short, so that 
a great deal of time will be spent out of doors. He especially cautions 
against the study of music, since there are very few who are able to 
pass through a thorough course in this branch without suffering more or 
less from hysteroid troubles. These children seem to have weak 
stomachs ; their digestion is easily affected by articles of food, that 
seem to have no evil effect upon their companions. Their appetite is 
capricious. The diet, therefore, should be a light one ; albuminous 
food, easily digested, starchy material, young vegetables and fruit, 
cooked, or, if raw, quite ripe. Medicine is of little benefit. It some- 
times becomes necessary to give iron, and great care should be taken to 
select a preparation that will not disorder the stomach. The prepara- 
tions of valerian have a palliative effect. Electricity may be used with 
temporary advantage. In obstinate cases, that resist the measures 
already suggested, we must resort to the treatment recommended by 
Dr. S. Weir Mitchell. 

The plan of treatment, in detail, is as follows : The patient must be 
confined to the care of a nurse, i. e., must be removed from relatives 
or parents. This is imperative. If circumstances do not permit of the 



204 DISEASES OF CHILDREN. 

removal of the patient to another building, he confines the child with 
its nurse to a room, forbidding visits of any sort. This part of the 
treatment is probably, the most difficult to carry out ; and if it is at all 
possible, the patient ought to be taken from the house of its parents. 
The next step in the treatment is to put the child to bed, where it re- 
mains until one week has elapsed from the time of disappearance of all 
symptoms. It is impossible, in any individual case, to predict how long 
it will be necessary to confine the patient in bed ; upon the whole, the 
time is shorter in children than in adults. He always, during the first 
period of the treatment, insists upon a strict observance of the following 
rules: The child is to be left to itself as much as possible. Neither 
playthings nor books are to be permitted. It is necessary that a cer- 
tain amount of moral force be allowed to act upon the patient in the 
beginning of the treatment. After the symptoms of the disease have 
begun to disappear, the nurse visits the child more frequently, or if 
necessary remains with it all the time ; the other restrictions are taken 
away, books and playthings are permitted, and the child is allowed to 
amuse itself. The patient is to have massage of the whole muscular 
system, applied every day, and this requires a trained nurse or manip- 
ulator. A weak interrupted current should also be applied daily. The 
sittings are not to be made too long, and the electricity especially 
seems to be very grateful to the patient. The diet at first should be 
milk only, the quantity given varying with the age of the patient. 
Very much less trouble is experienced in giving to children an absolute 
milk diet than to adults. After the digestive organs are perfectly re- 
stored to their normal condition, other albuminous food can be given, 
especially boiled and roasted meats. The condition of the bowels must 
be looked to. Sometimes we find constipation, sometimes the opposite, 
the result of the milk treatment. On account of continued diarrhoea, it 
even becomes necessary, in some cases, to desist from an absolute milk 
diet and to order meats from the beginning. The object of the diet is 
to give to the patient as much digestible food as his digestive apparatus 
will bear. The quantity is to be regulated by the condition of the 
individual, and food must be given frequently. It is not always that the 
patient is ansemic ; some of these patients are occasionally very fat, and 
with them nothing succeeds so well in reducing fat and making blood 
as this method of treatment. The principles of this treatment are so 
well stated by Dr. S. Weir Mitchell, and so thoroughly carried out by 



ICTERUS NEONATORUM. 205 

his results, that it is necessary only to refer to his works upon the sub- 
ject (Fat and Blood, Rest in the Treatment of Disease, and Nervous 
Diseases}. 



ICTERUS NEONATORUM. 



According to this author, in the majority of cases, -treatment is un- 
necessary, as the disease recovers spontaneously. In not a small num- 
ber of cases, however, the jaundice is complicated with other more 
serious diseased conditions. Many of these patients are extremely 
emaciated and feeble at birth, they suffer from sprue in the mouth and 
on the gums, and are affected with diarrhoea and vomiting. In such 
cases the proper treatment would be the use of an infusion of bark, with 
hydrochloric acid, mouth-washes of a solution of chlorate of potash and 
aromatic baths. 

PROFESSOR R. A. F. PENROSE, OF PHILADELPHIA, 

recommends the following formula : 

250. R . Hydrarg. chlor. mite, gr. j 

Sacch. alb., gr. xij. M. 

Ft. chart. No. xij. 
S. — One every two hours. 



According to this author, in infants and very young children, when 
the disease is occasioned by cold, little is required beyond keeping them 
warm, and giving no food except the breast milk. The skin will then, 
by degrees, regain its normal function. A small dose of hydrargyrum 
cum creta or castor oil may, however, be advantageously administered. 
In older children if there be pain or tenderness in the region of the 
liver, a few leeches or a linseed poultice may be applied. A few grains 
of grey powder may be given with a mixture of sulphate of magnesia 
and taraxacum or nitro-muriatic acid and gentian. A very important 
point is to keep the bowels well open. 



206 DISEASES OP CHILDREN. 



INCONTINENCE OF UEINE. 

DR. SAMUEL S. ADAMS. 

This author {American Journal of Obstetrics, 1884,) does not ap- 
prove of chloral with children. The bromides take foremost rank in the 
treatment of those cases in which an exalted nervous condition can alone 
account for the incontinence. They should be given in large doses at 
bed-time. Belladonna is the remedy par-excellence, in those cases be- 
lieved to be associated with a tonic spasm of the bladder. It should be 
given in large doses at bed- time, increased, drop by drop, daily, until 
improvement results or its physiogical effects are manifested. If there 
is relaxation of the sphincter vesicae or paresis of the muscles of the 
bladder, strychnia is indicated. 

When the prepuce cannot be retracted circumcision should be per- 
formed; but sometimes, while the opening in the prepuce is large 
enough, it cannot be retracted owing to adhesions. In such cases, if 
these adhesions are broken up, favorable results will follow. 

PROFESSOR ROBERTS BARTHOLOW, OF PHILADELPHIA. 

When there is acidity of urine and weakness of the sphincter with 
spasmodic contraction of the muscular layer of the bladder, this author 
{Archives of Pediatrics, 1884,) uses bicarbonate of potassium to meet 
the first indication, ergot for the second, (a pill containing one-fourth of 
two grains of aqueous extract of ergot, combined with one-fourth of a 
grain of extract of nux vomica), and a bromide for the third. A 
bromide is particularly indicated in those cases where the patient dreams 
of passing water. If the patient is anaemic, he would give the iodide of 
iron. The bromide should be given in a single dose at bed-time. 



recommends : 

251. R. Strychniae, gr. j 

Pulv. cantharid., gr. ij 

Morph. sulph., gr. iss 

Pulv. ferri, J)j. M. 

Make 40 pills. 

S. — One three times daily to a child ten years old. 



INDIGESTION. 207 

MR. ROBERTS ARTHUR JONES, OF ENGLAND, 

States in the British Medical Journal, 1880, that the treatment he 
has usually adopted and always found successful in " Nocturnal Incon- 
tinence," is sponging with cold water, night and morning, especially the 
loins, and the following mixture : 

252. R . Tinct. belladonnae, f. ^ ss 

Liquor potassii, 

Glycerinae, aa f. % ij 

Aquae, q. s. ad f. ^ viij. M. 

S. — Two tablespoonfuls night and morning (1ST. B. This dose, is, of 
course, intended for adults. Ed). 



INDIGESTION. 

DR. LOUIS STARR, OF PHILADELPHIA. 

According to this author (Archives of Pediatrics, 1884,) when we 
find the tongue perfectly clean, the appetite good, and neither eructa- 
tion, increased thirst, nausea nor vomiting, but great, uniform gaseous 
distention of the abdomen, without other symptoms, we have to deal 
with intestinal indigestion. In treating such cases, a careful regula- 
tion of the diet is important. The starches and fats must be excluded, 
because they are digested in the intestine. Three meals a day of the 
following articles of food should be taken. For breakfast, at 7:30 a. 
m., a bit of fresh fish or the lean of a mutton-chop, or a piece of tender 
beefsteak, with milk, (either warmed or not, according to taste,) and a 
single thin slice of stale bread without butter. For dinner at 2 p. m., 
the soft part of half a dozen oysters, a bowl of meat broth, entirely 
free from fat, or, instead of this a piece of lean beefsteak, roast mutton 
or beef, a little spinach, or well boiled cauliflower tops, and not more 
than a single slice of thin unbuttered bread. For supper, at seven 
o'clock in the evening, one or more glasses of milk, with a single slice 
of unbuttered bread. For drink, nothing but filtered water. The 
medicinal treatment must be directed to remedying the impaired pan- 
creatic secretion. For this purpose he orders : 

253. R. Ext. pancreatis, gr. xxx 

Sodii bicarb., 3J 

M. and ft. chart No. xij. 
S. — One powder to be taken 2| hours after each meal. 



208 DISEASES OF CHILDREN. 

Nux vomica is also indicated, partly to give tone to the muscles of 
the intestine, which must be in some degree weakened by the constant 
distention, and partly to encourage proper glandular action. He there- 
fore orders three drops of tincture of nux vomica with a teaspoonful of 
compound infusion of gentian, before each meal. 

Finally, to assist in the reduction of the abdominal distention, it will 
be well to rub the belly thoroughly twice a day with a stimulating lini- 
ment, such as turpentine and olive oil, one part to three. 



In The Practitioner, Dr. E. W. Dunbar, of Zurich, says that, for 
loss of appetite, in children, with pain after eating, nausea and depres- 
sion, if accompanied by a tongue either clean or slightly coated, but 
showing redness and enlargement of the papillae fungiformes, bismuth is 
very good. He gives it either in the form of subnitrate, in doses of 
one-half grain up to two, three and five grains, or the solution of the 
oxide in ammonia and citric acid, in doses of from two minims under 
one year to three, five, ten, fifteen and twenty minims, up to twelve 
years of age ; the dose to be repeated twice, or four times a day, 
according to the severity of the symptoms. Bismuth is quite ineffectual 
in the dyspepsia of children, when the tongue is smooth, clean, and 
shows no enlargement or redness of the papillae fungiformes. 

DR. EDWARD HENOCH, OF BERLIN. 

This author teaches that the dangerous consequences which may de- 
velop from a neglected dyspepsia, make early and careful treatment 
our duty, which can only be fulfilled with hopes of success when the 
surrounding conditions of life are favorable, and our directions are care- 
fully carried out. 

In many cases the patient is only seen after nature has removed the 
deleterious contents of the digestive canal by vomiting and diarrhoea. 
Here you need simply regulate the diet. If the child is nursed at the 
breast, the possibility of any deleterious change in the milk must be 
considered. It will be well to let the breast be taken less often than 
usual for a period of from twenty-four to thirty -six hours, substituting 
some thin oatmeal or barley gruel. If the appearance of menstruation 
in the nurse always produces dyspepsia in the child, she should be 
changed, but this rarely happens. 



INDIGESTION. 209 

If the child is fed on artificial diet, a series of experiments will re- 
veal the offending article. Dyspepsia will sometimes persist despite 
several changes in the nurses, and only disappear when the child is 
weaned. As long as emesis continues it will be well to give cold milk 
by the spoon, as drinking from the bottle readily induces overloading 
and vomiting. In fresh cases (not more than, three or four days stand- 
ing) he uses calomel as the first remedy. 

254. R . Hydrarg. chlor. mite, gr. j 

Sacch. alb,, gr. xij 

M. and ft. chart. No. xij. 
S. — One every three hours. 

Next to calomel comes hydrochloric acid, which yields good results 
in cases no longer acute. 

255. R. Acid, hydrochlor., gtt. vj-xv 

Aq. destil., f-5 n J 

Gum arab., gr. xv 

Syrup, alth., f-£v 

Tinct. opii, gtt. ij-iv. M. 
S. — Teaspoonful every two hours. 

In recent cases you should not add opium, as its constipating action 
causes tympanitic distention of the intestines. When calomel and 
hydrochloric acid fail, he uses creosote, especially when emesis is 
prominent, and also, when, after the subsidence of acute symptoms, 
thin, stinking evacuations continue. 

256. R . Creosoti, gtt. ij-iv 

Aq. destil., f.^j 

Syr. alth., f. 31 v. M. 

S. — Teaspoonful every two hours. 

When there is diminished secretion of gastric juice, pepsin may 
prove useful. 

257. R . Pepsiiige, gr. xv 

Acid, hydrochlor., gtt. vj 

Aq. destil., f.giv 

Sacch. alb., gr. cl. M. 

S. — One dessertspoonful four times daily. 

When the presence of mucus in the stools shows the beginning of a 
catarrhal condition of the intestinal mucous membrane, subnitrate of bis- 
muth may be used. After recovery, he uses rhubarb as a digestive 
tonic, which must be given for several weeks in the form of tinct. rhei 
vinosa (five to fifteen drops, three or four times a day, according to age). 
14 



210 DISEASES OF CHILDREN. 

INFANTILE PARALYSIS. 

ALLEN M'LANE HAMILTON, M. D., NEW YORK. 

The most active and useful agent in the therapeusis of this disease, is 
electricity , either as galvanism or faraclism, applied to the muscles. As, 
however, there is a central lesion, it is advisable to begin an energetic 
course of bromides and ergot (gtt. v of the fluid extract), with the 
actual cautery, before the atrophic condition commences. Strychnia is 
also an efficient agent. Young children may commence with gr. ih, 
which may slowly be increased. A palatable form is : 

Hammond's solution: 

258. R . Strychnise sulphatis, gr. j 

Quiniae sulphatis, 

Ferri pyrophosphates, aa £j 

Acidi phosphorici diluti, 

Syrupi zingiberis, aa f. ^ij. M. 

Sixteen drops contain gr. T ^o of strychnia. 

Cod-liver oil, sea-air, good food and tonics are all important. The 
paralyzed muscles should be treated by massage, heat and cold, and the 
faradic and galvanic currents. Some writers speak highly of 
" Jotjnod's Boot," the paralyzed limb being placed in the boot and the 
air exhausted. 

Much may be done to prevent the contractions and deformities which 
accompany old cases of this disease, by the daily use of passive exercises 
and shampooing ; recovery of power is often contributed to by the use 
of galvanism. The mild, continuous current is found to be especially 
useful in the class of flaccid muscles, whilst no good is ever done by 
galvanism in the class of rigid muscles. 

Dr. West gives in this disease mix vomica, gr. J to a child three 
years old, increasing the dose till it reaches J of a grain, thrice daily. 

The use of ergot has also been advocated, gtt. v of the fluid extract 
thrice daily, to a child two years old. 

The etiological treatment has reference to dentition, worms, constipa- 
tion, anaemia, preputial irritation, etc. 

DR. ARMAND SEMPLE, OF LONDON. 

Infantile paralysis proper, sometimes called infantile spinal paralysis, 
occurs in young children, and its exact nature, even now, is not thor- 
oughly understood. It shows a special tendency to affect children 



INFANTILE PARALYSIS. 211 

under two years of age. Sensation is totally unaffected, the paralysis 
being intrinsically motor. The invasion is usually sudden, is accom- 
panied by pyrexia, and terminates in atrophy ot the muscles and com- 
plete paralysis. The limbs are not always affected exclusively. The 
lumbar muscles may be implicated, and the spine curved to a greater or 
less extent. No morbid appearances are found in the brain or the 
cranial nerves. It may be caused by febrile or nervous affections; or it 
may follow cold and convulsions, diphtheria, ulcerated sore throat, or 
some eruptive fever. Blows and falls on the hip may produce the dis- 
ease. Delayed dentition in a rickety child must also be regarded as 
causative. As for treatment, absolute rest is imperative; fever symp- 
toms must be combatted with saline aperients and other appropriate 
remedies. A few leeches to the spine or counter- irritation by vesica- 
tive liniments may prove of service. Subcutaneous injection of ergo- 
tine has been recommended, since it is stated to control hyperaemia by 
contracting the small vessels of the spinal cord. Belladonna also con- 
trols hyperemia of the spinal cord and its membranes. Iodide of 
potassium, in small doses, combined with some vegetable infusion may 
prove useful. Quinine, iron preparations and strychnia are also con- 
sidered useful. The affected limb should be exercised daily and friction 
should be constantly employed. When the paralysis is advanced no 
benefit can be expected, save from faradization and galvanism. The 
continuous current should be applied to the affected muscles, at first two 
or three times a week, and eventually oftener. It should be used for 
about a quarter of an hour at a time, increasing the power of the cur- 
rent by degrees, as improvement results. After a time, the induced or 
Faradaic current may be used instead of the continuous variety. This 
form of paralysis is sometimes very chronic and obstinate, and the treat- 
ment has been continued in some cases for months and years. The 
apparently most hopeless cases may recover completely under proper 
local and constitutional remedies. The warmth of the affected muscles 
may be maintained by enveloping them in stockings of " chamois 
leather" or " pure spun silk." In some cases the seaside or mountain 
air is valuable. 

DR. WILLIAM PEPPER, OF PHILADELPHIA. 

This distinguished authority on diseases of children, says (Medical 
and Surgical Reporter, 1884,) that in treating the early stage of this 
disease, he thinks that it is well to act upon the supposition that there 



212 DISEASES OF CHILDREN. 

is irritation and congestion of the spinal cord. Counter-irritation along 
the spine and the use of ergot, belladonna and iodide of potassium 
internally, are indicated. At a later stage of the disease, when as 
much of the paralysis as will clear away has passed off, and there re- 
mains only the permanent paralysis which is associated with a serious 
lesion of the spinal cord, this line of treatment does not produce good 
results. We then have to depend upon remedies to promote the gen- 
eral nutrition, as iron and cod-liver oil, with correct hygiene, taking 
great care that the child is dressed properly and not exposed to damp- 
ness, draughts, etc. Friction of the skin should be employed to main- 
tain the circulation, for the child cannot take that incessant exercise by 
which young children maintain a healthy condition of their muscles and 
functions. In addition to this, there should be treatment especially 
directed to the paralyzed parts, hoping that the tone of the spinal cen- 
tres will be sufficient to enable them to maintain their integrity and pre- 
vent disintregation and atrophy of the nerve cells, which will be followed 
by wasting of the corresponding muscles. He does not know that we 
have any remedy that specially influences the nutrition of these im- 
portant nerve cells. Strychnia has no effect upon them, but acts only 
upon the motor nerves and the muscles. It is proper to use strychnia 
at a late period of the case, and it may be administered by the mouth 
or hypodermically, being injected into the affected muscles. The object 
of this treatment is to improve the nutrition of the muscle, and not to 
act upon the spinal cord. Massage, friction and passive movements 
should also be employed with the same object. The circulation of the 
skin should be stimulated by friction and warm clothing. Good results 
are often obtained by putting the affected member under an air-pump 
and exhausting the air. The limb is as it were enclosed in a large cup- 
ping glass, a vacuum is created, and the blood is drawn into the part. 
This carefully repeated is frequently of service. 

In private practice, we have scarcely the means of treating these 
patients as they should be treated. All that form of apparatus which 
has been brought to such perfection in Sweden serves an excellent pur- 
pose in the treatment of atrophic infantile paralysis. 

Electricity is an important agent in the treatment of this affection, 
but its use requires judgment and skill. That current is employed 
which will give contractions of the paralyzed muscles, and the inter- 
rupted galvanic current is practically the only one which is of service. 



INFANTILE SYPHILIS. 213 

It is to be used of such a strength and with the current interrupted at 
such a rate, and applied over the nerve points, the nerves themselves, 
or the muscles, according as you get the best results. There is no 
fixed rule to be laid down for the use of electricity, save that the cur- 
rent should be moderate, and used in such a way as to secure contrac- 
tions of the affected muscles. 

What we do for these cases in private practice is to promote nutrition 
by the use of iron, cod-liver oil, later employ strychnia, keeping up 
friction of the skin, and training the parents in the use of massage and 
passive movements, carefully regulating all matters of hygiene, and if 
we have time and a suitable battery, apply the galvanic current. These 
are cases which are more satisfactorily treated in institutions especially 
designed for this purpose. 

These cases require a long treatment, and if this is neglected the 
paralyzed muscles may pass into a condition of hopeless atrophy from 
disuse, and although the trophic centres of the cord may not be ruined 
by the original disease, the muscles from lack of proper treatment 
become hopelessly wasted. 

DR. TH0R0WG00D, OF ENGLAND. 

According to this author (Lancet, 1883), cases of paraplegia, and 
sometimes of the knee, of apparently obstinate kind, have been met 
with, where the cure has been missed from a want of attention to the 
condition of the intestinal canal. The late Dr. Graves, of Dublin, 
gives a case where a youth who had fed freely on nuts, had a distinct 
attack of paraplegia, only cured by the effectual purgation of his intes- 
tine from the crude mass formed by undigested nuts. Intestinal worms 
are sometimes a cause, and here the line of treatment is clearly indicated. 



INFANTILE SYPHILIS. 

EDWARD ELLIS, M. D., LONDON. 

This author remarks that mercury is the best sheet-anchor. In 
treating children he prefers the use of gray powder, in doses of from \ 
a grain, to 2 grains, twice to thrice daily, with a few grains of com- 
pound cinnamon powder to prevent the mercury running off by the 
bowels. This treatment should be persevered in from six to twelve 



214 DISEASES OF CHILDREN. 

weeks, occasionally substituting corrosive sublimate with bark. Vomit- 
ing and diarrhoea are indications for temporarily stopping the mercurial 
course, or at least for changing its form. Sometimes a little chalk or 
carbonate of potash added to the gray powder enables it to be well 
borne. Black-wash is the best local application ; anal condylomata 
should be dusted over with calomel, and kept scrupulously clean. 
Occasionally they may require a touch with nitrate of silver. Caustic 
is also useful in ulcerations of the mouth and tongue. Iodide of potas- 
sium, bark, sarsaparilla, and the syr. ferri ioclidi are of value, after the 
mercurial course, in improving the general health. Baths of corrosive 
sublimate are recommended in the skin complications. 
As examples of prescriptions he gives : 

259. R . Potassii iodidi, gr. ss-vj 

Spiritus ammonise aromatici, ^j-v 

Syrupi sarsaparillse, Tr\,x-f. gj 

Aquae, f.^ij-f.gj. M. 
For syphilitic cachexia in infants, p. r. n. 

Where the iodide of potassium does not agree, he prescribes the 
sodium iodide : 

260. R . Sodii iodidi, gr. iv 

Syrupi sarsaparillse, f. 3 ss 

Decocti sarsaparillae, f. 3 iv. M. 

R. W. TAYLOR, M. D., NEW YORK. 

In the monograph by this author {Syphilitic Lesions of the Osseous 
System in Infants and Young Children, N. Y., 1875,) he prefers, 
for the treatment of these lesions, a mixed plan, combining mercury 
and iodine. His usual prescription is : 

261. R. Hydrargyri bichloridi, gr. j 

Potassii iodidi, ^iv 

Syrupi aurantii, 

Aquas, aa f. % ij. M. 

Five drops for a child about two months old, increased to fifteen or twenty 
drops, if the disease does not yield. 

There need be no apprehensions of salivation, nor other noxious effects 
of the mercury, even if, as is generally the case, the medicine has to be 
continued for a long period of time, for the iodide, in this combination, 
corrects any such hurtful tendency. It is an important point in the 
treatment, to suspend the medicine altogether, from time to time, as, 
otherwise, the system will become habituated to its use, and it will fail 
of its remedial effect. 



INFANTILE SYPHILIS. 215 

A well-regulated and sufficient diet must be maintained while the 
child is under treatment. As a nurse is liable to contract syphilis from 
such an infant, cows' milk is the best resource, if the mother is not able 
to suckle it. 

Dr. Taylor advises strongly against both hypodermic injections and 
endermic inunctions of mercurials, as uselessly severe and of doubtful 
results. Locally, for ulcerations, he applies iodoform in the cavities, 
with a covering, to the other parts, of balsam of Peru ointment. Nodes 
on the scalp may receive daily frictions with mercurial ointment. When 
they degenerate into abscesses, a free crucial incision should be made, 
the detritus carefully removed, and the whole thoroughly mopped out 
with strong carbolic acid ; the cavity then to be stuffed with charpie, 
and cold-water dressing applied. The next day, this should be removed, 
and the cavity dusted with iodoform. Cold lotions should be continued 
as long as any inflammatory symptoms remain. 

DR. P. BRYNSBERG PORTER, NEW YORK. 

This practitioner states (American Journal of Obstetrics, July, 
1878,) that he has found, as a general rule, the treatment by mercurial 
inunction, to be the most serviceable, usually in conjunction with such 
tonic or alterant remedies as seemed indicated. It has the great 
advantage of not interfering with digestion, as is sometimes the case 
with agents given by the mouth ; though he has almost always found 
minute and somewhat frequently-repeated doses of calomel well borne, 
especially when their administration was intermitted from time to time. 
He generally combines the calomel with soda. 

DR. EDW T ARD HENOCH, OF BERLIN. 

According to this author, mercury is the only sure remedy for infan- 
tile syphilis. Its effects are often astonishing, and neither iodide of 
potassium nor iodide of iron can be compared to it. He prefers to use 
calomel and the black oxide of mercury in doses of from \ to 2 J grains, 
given morning and evening. The latter sometimes causes emesis, espe- 
cially at the beginning of the treatment. He regards every other form 
of administration of mercury improper, including mercurialization of the 
nurse. Inunction with gray ointment or the subcutaneous injection of 
corrosive sublimate should only be considered when extensive syphilitic 
eruptions are not present, or when intestinal complications prohibit the 
internal use of mercury. When there is marked atrophy, and vomit- 



216 DISEASES OF CHILDREN. 

ing and diarrhoea prohibit the internal use of mercury, he resorts to 
baths of corrosive sublimate (15 grains to the bath). Condylomatous 
growths he powders with calomel, or brushes daily with a solution of 
nitrate of silver (one grain to four drachms of water) if they have 
ulcerated. He also uses this solution for the nasal mucous membrane, 
if the coryza resists internal treatment. 

If the mother is syphilitic, she may, of course, nurse her affected 
child, but if she presents no evidence of the disease, she should only be 
allowed to nurse the child if the lips and buccal cavity of the latter 
present no abnormal appearances. Even the secretion of coryza must 
be regarded as a not altogether safe factor in nursing from the breast. 



According to this author, if the mother has previously given birth to 
syphilitic children, it is advisable to subject her to a mild course of 
mercury during her subsequent pregnancies. For the infant the most 
nutritious diet must be afforded ; no wet-nurse should be employed, in 
consequence of the risk of her becoming infected. During the presence 
of marked symptoms, some mercurial must be exhibited, such as 
hydrargyrum cum creta or calomel ; or this alterative may be conveyed 
to the system by inunction of mercurial ointment. 

A flannel roller may be smeared with ointment and bound round the 
child, by whose movements rapid absorption is occasioned. 'Small 
doses of the mercurial should be used, and they should be steadily con- 
tinued in order to affect the system; but this remedy should be stopped 
short of salivation, which occurrence is, however", rare in children, and 
it should be discontinued temporarily, if any gastric symptoms arise. 
The mercurial may be followed by iodide of iron or iodide of potassium, 
either separately or together. Liebig's extract of meat and raw beef 
finely scraped, are often valuable in supporting the strength of the 
patient. If any sores are present, they may be treated with black 
wash, and if condylomata are present, they may be touched from time 
to time with solid nitrate of silver or dusted with calomel. 

DR. ARCIIAMBAULT, OF PARIS. 

This distinguished authority, says (Gazette Des Ilojritaiiz, 1882,) 
that u when the child is suckled by its mother or nurse, you have two 
modes of treatment, the one complementary to the other — the direct 
treatment of the child, and the indirect treatment of the mother or nurse, 



INFANTILE SYPHILIS. 217 

to whom you give the suitable medicinal substances. But this latter 
mode of treatment is only an adjuvant, and employed alone it would 
prove absolutely insufficient. How is the infant to be treated directly 
by mercury ? The preferable mode is to administer the sublimate dis- 
solved in water or in milk, with which it will form without any incon- 
venience (notwithstanding what has been said about it) an albuminate 
of mercury. Baumes commences with one, one and a half, or two milli- 
grams, progressively increasing the dose to six milligrams in the twenty- 
four hours ; Bertin commences with two milligrams, to reach four, his 
maximum dose ; Cullerier begins with five milligrams ; and Bassereau 
prescribes the dose for an adult reduced to a fourth or a third, which 
comes to pretty much the same. A milligram and a half seems a very 
small affair ; but if you compare the weight of a child with that of an 
adult (the mean weight of an infant being five kilograms, while that of 
an adult is seventy), you will find that the dose advised for infants is 
comparatively a large one. He ordinarily commences with a milligram 
and a half per diem, and, according to the condition of the little patient, 
gradually reaches the maximum of five or six milligrams. All depends 
upon whether we have to do with a slight syphilis or with grave symp- 
toms. In certain cases, when he has found a true cachexia with gastro- 
intestinal disturbance, he has begun with four milligrams from the first 
day. We may employ the liquor of Van Swieten, which is a solution 
of the sublimate in the proportion of a thousandth part, and which 
allows the quantity of mercury you wish to give to be very easily dosed. 
Thirty drops of this liquor correspond to one milligram and a half of the 
sublimate, and he prescribes them to be taken in milk, in three doses, 
morning, afternoon and evening, increasing by two drops every other 
day, until the maximum is attained. In the infant you do not find, as 
in an adult, any positive sign of the mercurial saturation of the organism, 
and the sole rule you have to guide you is the local and general condi- 
tion of the child. Thus you will no longer continue to increase the 
dose when you find vegetations subsiding, ulcerations filling up, and 
spots disappearing, etc. 

" Mercurial treatment has been accused of inducing intestinal dis- 
turbances and provoking diarrhoea ; but it is exactly the contrary of 
this which takes place, and, save in some exceptional cases, the diar- 
rhoea, which existed prior to any treatment, disappears almost always 
under the influence of mercury. Still, should the diarrhoea persist, or 



218 DISEASES OF CHILDREN. 

should it appear under the influence of a peculiar disposition, you may 
add, according to its intensity, a half or a whole drop, or even two 
drops, of laudanum to the liquor ; or still better, you may prescribe 
five centigrams of liydrarg. cum creta twice a day, to which you may 
add, if required, half a drop of laudanum. External treatment may 
be employed either alone, or concurrently with internal treatment ; but 
he only has recourse to it when mercury is not tolerated internally, and 
on the condition that it is very effectually administered. A gram and 
a half of mercurial ointment may be rubbed in night and morning, con- 
tinuing it for a considerable time, and varying the part on which the 
friction is made, in order to avoid producing eczematous eruptions. 
For the same reason the frictioned parts should be washed, from time 
to time, with mild soap. The curative effects of these frictions do not 
admit of doubt, and in cases of slight manifestation of the disease they 
may suffice. Nevertheless, whenever it is possible, he associates the 
internal with the external treatment. Sublimate baths also may be 
employed as adjuvants to general treatment in cutaneous manifestations 
of the disease. The dose for an infant is from two to six grams per 
bath. This may be used even in any metallic bath, on condition of add- 
ing ten to fifteen grams of the chlorhydrate of ammonia, or even of 
simple chloride of sodium, in order to obviate the effects of the decom- 
position of the mercurial salt in presence of a metal. 

" Such is the mode of treating the general accidents of hereditary 
syphilis in infants, a treatment to which we must add a good hygiene. 
Thus, alimentation should be severely watched, and especially if the 
child is brought up on the bottle, which is the case when the mother 
will not suckle her infant, and under the difficulty there is of finding a 
nurse who will consent to suckle a syphilitic infant, in the face of the 
risks she runs, unless she herself has been syphilizecl. Great care 
also must be taken to preserve the infant from the impression of cold, 
Vhich may induce severe intestinal disturbances. It is well known, in 
fact, that if syphilis is of more frequent occurrence in warm climates, 
it is also there cured more easily." 

DR. THOMAS. 

As a means of treatment, this author QArch.f. Kinderh, B. V. H. 
3 and 4,) gives the preference in all cases to mercury over iodine. 
Mercurialization need not be dreaded, for it very rarely occurs. He 
prefers calomel in doses of from one to three-hundredths of a grain, 



INFANTILE SYPHILIS. 219 

three to four times a clay. If there is severe diarrhoea, a little opium 
may be given with the calomel. For condylomata and other skin affec- 
tions, calomel is also recommended. Sublimate baths (one to three 
grains to a bath) are also very useful. Care must be taken to prevent 
the water from getting into the mouth. For children from one to two 
years of age inunctions are quite proper and efficient ; they are not ad- 
visable for younger children, because they may produce an eczema. In 
lieu of calomel, the yellow iodide of mercury may be given two or 
three times a day, in doses of one-hundredth of a grain. Later, if the 
symptoms of the disease have not disappeared, a solution of the iodide 
of iron may be given with advantage. 

DPS. MEIGS AND PEPPER, OF PHILADELPHIA. 

If the previous children of a mother have proved syphilitic, it is well 
to subject her to a mild mercurial course during her pregnancy. In 
the treatment of the infant, every care must be paid to support its 
strength by the most nutritious diet, if it is unable to suckle the 
mother. It is, however, improper to employ a wet-nurse, on account 
of the danger of her being infected by the child. In regard to medic- 
inal treatment, the use of mercury is universally recommended during 
the presence of marked symptoms. The mercurial may either be given 
in the form of hydrarg. cum creta, calomel, or bichloride of mercury, 
in solution in some aromatic water or syrup ; or finally, it may be in- 
troduced into the system in the form of mercurial ointment by inunc- 
tion. The most convenient mode of introducing it in the latter form is 
by smearing a flannel roller with mercurial ointment, and binding it 
around the child, whose movements cause its speedy absorption. The 
dose of the mercurial should be small and it is to be continued steadily, 
though with caution, so as to avoid producing salivation, until a decided 
improvement in the symptoms manifests itself. During its administration, 
it will frequently have to be discontinued temporarily, on account of 
gastro-intestinal irritation. So soon as the mercury is stopped, we 
should order the iodide of potassium or iodide of iron, either one or 
both together being employed according to the toleration of the 
stomach. We should also recommend the use of cod-liver oil, and 
some preparation of cinchona, from an early period in the case ; and 
even when the child suckles, a certain amount of Leibig's cold extract of 
meat or of raw beef scraped finely should be given. 

The best application to the sores is black- wash, though the condylo- 



220 DISEASES OP CHILDREN. 

mata usually require to be touched occasionally with solid nitrate of 
silver. 

PROF. J. STEINER, M. D., PRAGUE. 

As the result of his extensive experience in the Francis Joseph 
Hospital of Prague, this writer advises the mercurial treatment in 
infantile syphilis. The preparation he prefers is calomel, which he 
gives in doses of gr. J-J--J, three or four times a day. If there is 
anaemia, he combines it with saccharated carbonate of iron ; if colic 
and sleeplessness, with Dover's powder. He also uses calomel, locally, 
for condylomata, fissures, ulcers, etc. 

He believes the calomel acts best on lesions of the skin ; but when 
the bones and viscera are involved, he prefers iodine, giving it either 
as iodide of potassium, or as syrup of the iodide of iron. The long- 
continued use of any form of the drug, he considers prejudicial ; but 
he has observed a wide difference in the tolerance of the drug in infants. 
He uses tincture of iodine for a local application to syphilides. 

NOTES ON REMEDIES. 
Hydrargyrum Tannicum Oxydulatum. Professor Monti, of Vienna, is much 
pleased with this preparation in cases of hereditary infantile syphilis. 
The tannin prevents the diarrhoea, which so often occurs in the exhibi- 
tion of calomel and other salts. His formula for infants is : 

262. R. Hydrarg. tannic oxyd., gr. iss-iij 

Sacch. alb., gr. xlv. M. 

Div. in pulv. No. x. 
S. — A powder every two or three Lours. 

(Archives of Pediatrics, 1884.) 



INFLUENZA 



DR. FILATAFF, OF RUSSIA. 

This author considers (Medic. Oborsen, 1883,) that the occurrence 
of influenza during childhood has not received the attention which it 
deserves in text-books on diseases of children. He defines influenza as 
a febrile epidemic catarrh, which attacks simultaneously or in succession 
the mucous membranes of several organs. The younger the child, the 
more severe the disease is apt to be, prevailing most frequently among 
children from six months to five years of age. Taking cold has more or 



INTERTRIGO. 221 

less influence in developing the disease, though it is likely that it is 
propagated by a contagium of some sort. The period of incubation is 
from one to three days. As to differential diagnosis, acute simple 
bronchial catarrh is chiefly to be considered, and influenza is to be dis- 
tinguished, (1) by its propagation as an epidemic; (2) by the simulta- 
neous affection of the mucous membranes of other organs ; (3) by the 
intensity of the fever and cough, which are not like those of ordinary 
catarrh ; (4) by the long duration of the catarrh ; (5) by the participa- 
tion of the nervous system in the disease. The moderate reddening of 
the pharynx, without the presence of points or patches, will distinguish 
it from measles. In addition the frequent sneezing of measles is absent. 
Should the influenza co-exist with continuous fever and diarrhoea, 
typhoid fever may be suspected. But in the former the cold in the 
head will persist from the beginning, while the coughing will precede 
the diarrhoea, and the extraordinary irritability of the patient will be a 
pronounced feature. As prophylactic treatment, protection from colds 
is recommended, and also cold baths. With delicate children, a pro- 
longed sojourn in the country will have a prophylactic effect. Large 
doses of quinine at the beginning of the disease sometimes have a cura- 
tive effect. Apomorphia is recommended for the dry cough. When 
pneumonia of long duration has complicated the disease, a change of 
climate is urgently demanded. 



INTERTRIGO. 



M. KLAMM. 

This author {Medical and Surgical Reporter, 1882,) recommends 
the following as very effective in all forms of intertrigo in infants. 

263. R . Magnes. calcin., gij 

Talc, powder, giv 

Acid, salicyl. pulv., gss. M. 

All the ingredients, particularly the magnesia, should be reduced to 
very fine powder. Salicylic acid may often be advantageously replaced 
by boracic acid. This powder has also been often employed with very 
great success against the various forms of erythema and eczema, which 
are developed about the anus in young children, under the influence of 



2^2 DISEASES OF CHILDREN. 

diarrhoea. It is of great benefit too. in seborrhea of the scalp, in 
ulcers of the loiver limbs, and as an application to vesicated surfaces. 

DR. WERTHEIMBER, OF MUNICH, 

Recommends (La France Medicale, 1880,) washing the child with 
soap and warm water, giving it bran baths, and powdering the healthy 
skin with lycopodium or a mixture of equal parts of oxide of zinc and 
subnitrate of bismuth. On the affected parts, he prefers the unguentum 
diachyli of Hebra, with olive oil. In old-standing cases he makes appli- 
cation three or four times a day of a solution of bichloride of mercury 
g r - j-5iv. 

DR. GEORGE HENDY, OF MICHIGAN, 

Dusts the affected parts with finely powdered red cinchona bark, after 
washing well and drying, not by rubbing, but by dabbing with a soft 
towel. If the alvine evacuations are acid or in any way irritating, he 
corrects them. The application of the powder is made every time the 
child is changed, and at no time are soiled or wet diapers allowed to 
remain on the parts. (Med. and Surg. Reporter, 1880). 



INTUSSUSCEPTION. 

DR. EDWARD HENOCH, OF BERLIN. 

By far the largest number of invaginations in childhood occur during 
the first year. The diagnosis of this condition depends chiefly on the 
association of three symptoms; viz.: constipation, vomiting, and escape 
of blood from the anus. As a rule the disease begins suddenly, in the 
midst of perfect health, with violent cries, great restlessness, repeated 
vomiting and constipation. Purgatives and enemata are ineffectual; 
the latter are immediately evacuated, and an escape of blood from the 
anus frequently occurs on the first day, and almost always later in the 
disease. At first it is mixed with faeces, later with mucus, but may 
also be discharged pure, in part coagulated, in varying quantity. 
Tenesmus is rarely absent, and five, six or more passages often occur in 
the course of a day. During the first twenty-four to forty-eight hours 
the abdomen may retain its usual shape and softness, but then it usually 
becomes tense, tympanitic and tender. So long as the abdomen is soft 



INTUSSUSCEPTION. 223 

and its walls yielding, we can detect by palpation the tumor produced 
by the invagination, not so, after it becomes tense. Occasionally, by 
introducing the finger into the rectum, we can feel the rounded tip of 
the intussusception. In the unfavorable cases, which constitute the 
large majority, there is increased meteorism, constant whimpering and 
crying, which finally give place to complete apathy, cool cheeks and 
extremities, small and extremely frequent pulse and finally, fatal coL 
lapse after an average duration of the disease of from four to eight 
days. In favorable cases, there is restoration of the invagination, with 
discharge of flatus and faecal evacuations, or necrotic desquamation of 
the invaginated portion of the intestine, with formation of a more or 
less normal intestinal lumen, and a corresponding shortening of the 
canal. He would advise in all cases the trial of ice-water enemata, 
used every hour or two, and still more profuse irrigations of ice-water, 
even though it be immediately ejected again. By the mechanical 
pressure of the fluid, this plan may effect the same object which is 
sought by other mechanical methods of reduction, viz.: blowing air into 
the intestines with bellows, and the introduction of a whale-bone bougie, 
armed with a sponge, with which the attempt is made to thrust the 
invagination felt in the rectum upwards. A small number of cases have 
been cured by these methods, and no opposition can be made to their 
cautious employment, when they are discontinued forthwith, if they do 
not soon prove successful. The danger lies in the fact that we can 
never foretell whether the intussusception is still reducible or has be- 
come fixed from adhesion of both serous layers (of the intussusception 
and of its so-called sheath). In this event, every forcible attempt at 
reposition may cause rupture of the adhesions and the serous membrane 
itself, the effects of which cannot be calculated. Pain may be relieved 
by small doses of opium or morphia. The diet should consist of wine 
and iced milk, given in spoonfuls. In a few cases it has been said that 
holding the patient up by the legs or massage of the abdomen, espe- 
cially in the situation where the tumor is felt, has produced reduction 
of the latter. In desperate cases, laparotomy, followed by disentangle- 
ment of the intussusception or the formation of an artificial anus, has 
proven successful in a few exceptional cases ; but, after finding the 
invagination, it is almost always impossible to withdraw it from the 
lower portion of the intestine. 



224 DISEASES OF CHILDREN. 



This physician states, in the JV. Y. Medical Journal, 1882, that he 
has succeeded in curing three cases of intussusception in infants by the 
administration of chloroform, injections of warm water and the applica- 
tion of massage to the mass felt through the abdominal walls. He 
knows of two other cases, where all the usual measures failed and re- 
duction was effected by chloroform and massage. The children, in all 
these cases, were held, and the injections forced into them against all 
voluntary and involuntary efforts that they could make. In one case 
the gut had been invaginated for forty hours, and in another for three 
days. In one case, the water, after three or four bulb-fulls were thrown 
in, was ejected. This was repeated constantly ; it seemed almost im- 
possible to get the gut to retain any water. Finally, an assistant 
resorted to massage (the child being under chloroform) . Immediately 
there was a roar of rushing wind and water, and a large amount of 
water forced in and was apparently retained. The child was laid down, 
and warm bottles put around it, to rally it after the ordeal; the bowels 
were moved in a short time, and a rapid recovery ensued. 

DR. A. GEIGER, OF OHIO. 

This physician reports (Medical and Surgical Reporter, 1881,) a 
case of intussusception in an adult that was cured by injections of cold 
water. 



According to these authors there is no special plan of treatment for 
intussusception deserving the name of preventive, owing to our igno- 
rance of any symptoms which can be definitely regarded as the pre- 
cursors of the invagination. The fact, however, that various derange- 
ments of digestion, such as pain upon going to stool, diarrhoea, or 
constipation alternating with diarrhoea, have been occasionally noticed 
to precede the attack, should be an additional motive to urge us to meet 
these symptoms by the most assiduous attention to the hygiene of the 
child and to the regulation of its alimentary functions. 

The curative treatment may be divided into three classes, the medical, 
mechanical, and surgical treatment. 

Medical Treatment. — Depletion is strongly contra-indicated by the 
tender age of the patients, and by the necessity of preserving the vital 
powers; since elimination, which affords the principal chance of re- 



INTUSSUSCEPTION. 225 

covery, does not occur until after the eighth day. In order, ho'vever, 
to relieve the engorgement at the point of constriction, without reduc- 
ing the strength of the patient, it is advisable to apply a few leeches, 
or cups to the abdomen, and preferably to the right iliac region, unless 
a tumor can be detected, when they should be applied over its seat. 

During the early stage of the attack, before the symptoms of intus- 
susception are very positively developed, they advise the administration 
of a mild, but thorough laxative, such as castor oil, in conjunction with 
large laxative enemata. If, however, at the end of twenty-four or 
forty-eight hours, the administration of these remedies, aided by the 
local depletion, has failed to produce an evacuation from the upper 
bowel, these measures should be abandoned, and recourse be had to 
means of calming pain and nervous disturbance, and to the sustentation 
of our patient. Among the best remedies to accomplish these results 
are opium, warm anodyne poultices to the abdomen, and warm baths, 
carefully given. These latter are especially serviceable, when the symp- 
toms of nervous disturbance are marked, even amounting, as they 
occasionally do, to general convulsions. In endeavoring to sustain the 
child's strength, attention must be paid to the vomiting, which is gen- 
erally so severe as to prevent any nourishment being retained. The 
remedies of most service against this are counter-irritants to the epigas- 
trium, opium, hydrocyanic acid, carbonated water, small pieces of ice 
kept constantly in the mouth or swallowed whole. Nutritious enemata 
may be tried, but they are rarely retained. 

The mechanical treatment consists in the injection of fluids or air 
into the bowel in such quantities as to distend it ; and in the introduc- 
tion of a large sound, with the view of pushing up the invaginated 
portion of the intestine. The fluid may be introduced by an ordinary 
syringe, the limbs being held together so as to prevent as far as possi- 
ble any reflux. Simon recommends hydrostatic pressure, as follows : 
a glass funnel attached to a long india-rubber tube terminating in an 
olive-shaped plug is used. The plug is inserted in the anus, and the 
funnel is held on a level with the body, and water is poured in until 
it is filled. The funnel is then gradually elevated, and more and more 
water poured in to replace that which is forced by hydrostatic pressure 
into the boweL Owing to the gradual and uniform increase in pressure 
thus brought about, extreme distention of the entire colon can thus be 
produced. 
15 



226 DISEASES OF CHILDREN. 

To introduce air, we can use a pair of ordinary bellows ; the nozzle 
being inserted well into the rectum, and inflation being continued until 
the obstruction yields. The return of the invaginated intestine is some- 
times attended by a clearly audible sound, a species of crack, but it 
never gives any pain and has generally seemed to afford relief. The 
complete restoration of the calibre of the intestine is proved by the co- 
pious feculent stools, which frequently come away soon after the inflation. 
To obtain the best results, inflation should be employed early in the 
case, before any considerable amount of adhesive inflammation has taken 
place between the sheath and the contained intestine. Dr. Niessen 
has recommended the pushing up of the invaginated portion by means of 
an oesophageal sound protected by a sponge. This proceeding, our 
authors consider, would probably be readily accomplished, if the intus- 
susception occurred far down in the large intestine ; but it would appear 
very difficult to replace in this way, an invagination as high up as the 
ileo-csecal valve. 

The surgical treatment consists in the performance of the operation 
of gastrotomy, finding the invaginated portion of bowel and reducing it 
by gentle traction. Our authors have seen that in the majority of cases 
the invaginated portion of bowel will be found in the neighborhood of 
the left iliac fossa. The great danger of the operation is, of course, ap- 
parent, but should hardly be considered an objection, when we consider 
the fatal nature of this affection. Our authors thus sum up. After 
having tried for two or three days the medical and mechanical means re- 
commended without success, we must forbear and decide whether to 
trust the case to nature, with the hope of elimination of the invaginated 
bowel occurring, or to resort to gastrotomy. And in this decision, the 
circumstances of each case must be taken into account ; for, if the case 
has not yet progressed so far that adhesive inflammation has certainly 
taken place, and if we are able to detect the exact seat of constriction 
by the presence of a tumor, the operation certainly has strong argu- 
ments in its favor, and should not be hastily rejected. In those cases 
which have been trusted to nature, and when elimination has fortunately 
occurred, we must treat the child, during this crisis, with the utmost 
care. The diet must be rigidly regulated, and the child kept in abso- 
lute repose. Nor must we relax these precautions for several weeks, 
and allow either indigestible food, or too large a meal of even the most 
digestible articles ; since death has been several times known to follow 
this imprudence, from a rupture of the imperfectly-formed cicatrix. 



LARYNGITIS (ACUTE). 227 

LARYNGITIS (ACUTE). 

DR. E. FLETCHER INGALLS, OF CHICAGO. 

According to this author (Chicago Medical Journal and Examiner, 
1880,) acute laryngitis in young children requires more vigorous treat- 
ment than in adults, because of the small size of the larynx, and the 
greater liability to spasm of the glottis. In treating these cases the 
warm bath should be used at first, to relieve the engorgement of the 
mucous membrane and tendency to spasm. The atmosphere of the 
room should be kept moist by steam, and the temperature kept up to 
80° F. or 85° F., and when possible, the little patient should be 
induced to inhale steam from the atomizer. Frequently, young children 
become very much alarmed by the atomizer, when brought close to 
their faces, but they will get some benefit from it though it is placed 
three or four feet away. A great deal of benefit will frequently be 
derived from warm applications, care being taken to keep the parts con- 
stantly warm and moist. For this purpose, poultices of flaxseed are as 
good as anything ; or you may use cloths wrung out of hot water, or 
spongiopilin with warm water, which latter is an elegant application. 
Whichever of these is employed, it must be kept constantly hot, for if 
allowed to cool it will do more harm than good. If these cannot be 
kept warm, it is much better to apply dry cloths. Turpentine stupes 
to the neck have also been found beneficial. If there is much tendency 
to spasm, the compound syrup of squills may be given, or small doses 
of belladonna, which not only relieve the spasmodic tendency, but pos- 
sibly have some specific curative effect on the mucous membrane of the 
throat. 

If oedema comes on, you should make an effort to scarify the part ; 
but generally this cannot be effected in young children ; failing in this, 
by passing the finger over the base of the tongue you will sometimes 
be able to tear the mucous membrane with the nail, and thus allow the 
serum to escape. If you cannot relieve the oedema, and the dyspnoea 
continues to increase, do not hesitate to resort to tracheotomy, which 
holds out very good chances for recovery. 

In a few rare instances of acute laryngitis in young children, the 
dyspnoea seems to be due to inflammation of the posterior crico-aryte- 
noid muscles, which are the abductors of the vocal cords. The glottis, 
during respiration in health, is a triangular chink ; but with paralysis 



228 DISEASES OF CHILDREN. 

of these muscles, the cords are drawn together during inspiration, so as 
to greatly interfere with the ingress of air. In one case of this sort, 
reported by Dr. J. Solis Cohen, it was found that the application of 
ice-bags to the neck every minute for about eight hours, succeeded in 
inducing reflex respiratory movements, which carried the child over the 
critical period. 

DR$. MEIGS AND PEPPER, OF PHILADELPHIA. 

The most useful internal treatment that our authors have found has 
been the exhibition, three times a day, of a fluid-drachm of one of the 
following mixtures, diluted with a little water : 

264. R. Potass, carbonat, 9j 

Tinct. opii, gtt. xxiv-xlviij 

Syr. senegse, f.&j 

Syr. tolutani, f-5 v J 

Aq. fluvial, f.gij. 
Ft. sol. 

265. R . Ammonii bromidi, gr. lx-xcv 

Ammonii muriatis vel potassii chloratis, gr. xlviij 

Tinct. opii deodoratse, gtt . xxiv-xlviij 

Syr. scillse, f. z iij 

Elix. calisayae, f. Sj 

Aquae, q. s. ad f. \ iij. 

Ft. sol. 



LARYNGISMUS STRIDULUS. 

PROFESSOR WIDERHOFER, OF AUSTRIA. 

In a clinical lecture {Allgemeine Wiener Medicinishe Zeitung, 
1884,) Professor Widerhofer recommends traction of the tongue dur- 
ing the attack, to prevent closure of the glottis, or sprinkling water in 
the face. In the intervals, he gives bromide of potassium and regards 
this as almost a specific for these spasmodic attacks. The remedy 
must be given in rather large doses, four grains morning and evening, 
gradually increased to eight grains. In one or two days, he claims, 
the attacks will have wholly ceased to occur. 

DR. W. H. DAY, OF ENGLAND. 

According to this author's teaching, found in the Medical Press and 
Circular, 1880, the first indications are to remove all exciting causes. 
If the bowels are disordered they should be set right as soon as possi- 
ble by proper aperients, and healthy digestion promoted. If the child 



LARYNGISMUS STRIDULUS. 229 

has taken a heavy meal, or indigestible food, an emetic may be advisa- 
ble ; and should the gums be swollen, and dentition appear to invite the 
complaint, they ought to be scarified. The child should occupy an airy 
apartment, and noise and excitement be precluded. If seen during the 
paroxysm it should be kept in an upright position, and the windows 
opened, so that it may be encouraged to breathe. In severe cases, 
especially if a convulsion threaten, it may be immersed in a warm bath, 
while cold water is sprinkled at the same time over the face. Dr. 
Morley Rooke recorded a case of laryngismus stridulus in a child nine 
months old, where occlusion of the larynx during the fit produced 
symptoms like those of " a recently drowned person." The little 
patient " showed no sign of life," when first seen in the seizure ; the 
lips were blue and swollen, the face a livid gray, and the eyes half 
closed and glassy. Dr. Rooke thrust his finger between the teeth to 
the fauces, when the child gave a short heave and a gasp ; on repeating 
the movement inspiration took place, and in a few more seconds breath- 
ing ensued. On two more occasions, when occlusion of the larynx was 
equally severe, a similar manoeuvre brought round the child. This is a 
mode of treatment well worth bearing in mind when the child threatens 
to die from spasm of the glottis. The cure was completed by bromide 
of potassium, which was taken for eleven months. Dr. Wardell also 
points out the beneficial effect of " rotating the finger in the throat" in 
these cases ; it induces an attempt to vomit, when the laryngeal muscles 
become relaxed, and air is admitted into the trachea. He says it is the 
first thing to be done, and he has seen it succeed when death seemed 
imminent. In extreme cases, where death threatens from asphyxia, 
the operation of tracheotomy should be employed. The inhalation of 
chloroform has been recommended in some cases, but then its influence 
soon passes off, and it cannot be said to have any curative effect. When 
there is much restlessness, and the child can obtain no sleep, the ex- 
citability of the nervous centres must be calmed, and for this purpose 
small doses of morphia may be cautiously employed. In the intervals 
of the seizures the bowels must be kept freely open, so as to remove 
all sources of irritation that might sympathetically excite spasm. 

Among the chief drugs are belladonna, in the form of extract or 
tincture, which sometimes has the effect of diminishing the glottic 
spasm, but in most cases it fails altogether. Bromide of potassium is 
very serviceable given with citrate of potassium, sal volatile, or quinine 



230 DISEASES OF CHILDREN. 

according to the peculiarities of each case. Carbonate of ammonia, 
henbane, bark, and mild preparations of iron, as the ammonio-citrate, 
or the syrup of the iodide, are remedies to be selected. If the child 
• is strumous and rickety, or in any way delicate, cod-liver oil is invalu- 
able. It is a remedy which ought to be persevered with, as by improv- 
ing the general health Ave may so keep off the disease. 

Diet is of great importance, and, when carefully selected, the disease 
may disappear without drugs. If the child is fed at the breast, it is 
sometimes advisable to change the nurse or to give cow's or ass's milk. 
If older the food must be light and nutritious, and given frequently, in 
small quantities. The clothing should be warm, and if the child is not 
too ill, he ought to be taken out in the open air daily. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

When the disease seems to immediately depend upon difficult den- 
tition, the gums ought to be carefully watched, and freely scarified, so 
soon as there is the least heat or swelling over the advancing teeth. 
When the disease depends on gastric irritation, the result of an un- 
healthy milk or of artificial diet, our attention must be directed chiefly 
to removing these conditions. When the child is thin and pale, and 
the stomach evidently weak and dyspeptic, it is well to resort to small 
quantities of stimulants, and to tonics in proper doses. The best 
stimulant is fine old brandy, of which from ten to twenty drops may be 
given three or four times a day, or every two or three hours. Or we 
may administer the aromatic spirits of hartshorn, with or without 
brandy ; of this, about ten or fifteen drops should be given four or five 
times a day. Of tonics, the most suitable, are quinine, in the dose of 
a quarter to half of a grain, three or four times a day, or the citrate of 
iron and quinine, in the dose of half a grain, given in the same way. 
Another very excellent stimulant and tonic is Huxham's tincture of 
bark, of which about five to fifteen drops may be prescribed in the 
place of brandy. When the disease is associated with marked intes- 
tinal irritation, we must inquire carefully into its nature and cause. It 
may be connected with constipation, diarrhoea, or with an unhealthy 
state of the contents of the bowels. It is often dependent upon the 
presence of crude or imperfectly-digested articles of food in the alimen- 
tary canal, and when this is the case, the only proper method of treat- 
ment is to attend to the state of the digestive functions, and to discover 



MAMMARY GLAND; ENLARGEMENT OF. 231 

and employ a proper diet. The bowels are frequently very torpid, 
and the stools, when obtained by medicine, are often found to be very 
offensive, light-colored, and pasty, corditions generally resulting from 
imperfect action of the liver. Under these circumstances, small doses 
of mercurials, or taraxacum, should be resorted to in combination with 
or followed by light aperients, as castor oil or rhubarb. One of the 
very best cathartic remedies, when this* combination of symptoms is 
present, is Chaussier's mixture of castor oil and aromatic syrup of 
rhubarb, consisting of three parts of the former rubbed up with five 
parts of the latter. The dose is a teaspoonful every two or three 
hours, until the bowels are well evacuated. It is gentle in its action, 
and yet very efficient, gives no pain, and is easily taken. If a mer- 
curial be desired, about two or three grains of blue mass, one or two 
grains of calomel or four grams of the mercury with chalk, may be 
incorporated into the mixture. When diarrhoea is present, it must be 
treated according to its causes. When, on the contrary, constipation 
is a marked symptom, this is to be treated by regulation of the diet, by 
the daily use of warm water enemata, or, if these do not answer, by the 
exhibition of small doses of the mildest aperients. In cases apparently 
connected with enlargement of the bronchial or cervical glands, the 
treatment should be directed to the invigoration of the general health 
by attention to diet, by the use of tonics and by proper exposure to 
fresh air, whilst we should employ internally, cod-liver oil, iron, iodide 
of potassium, the preparations of iodine and anti-spasmodics. When 
the disease persists, in spite of the means recommended, and especially 
when it depends on dentition or digestive irritation, change of air will 
often produce a wonderful effect, and should always be tried. 



MAMMARY GLAND ; ENLARGEMENT OF. 

DR. EDWARD HENOCH, OF BERLIN. 

According to this writer the secreting mamma may become the site 
of diseased processes in the new-born, as in the adult woman. The 
local process may simply become intensified into inflammation, which 
first causes enlargement of the gland, and may then lead to the forma- 
tion of abscesses. He simply covers the tumor with cotton dipped in 
oil. If redness and suppuration occur, the discharge of the abscess 
may be hastened by warm cataplasms and incision. 



232 DISEASES OF CHILDREN. 

MALARIA. 



This author describes a condition of " weak spells " occurring in 
infants as the result of malarial poisoning. In a case which he reported 
to the Obstetrical Society of Philadelphia, 1884, the mother suffered 
from malarial fever during pregnancy and was obliged to take quinine. 
When the child was one week old, it had " weak spells/' accompanied 
by coldness of the skin and prostration, lasting fifteen to twenty minutes. 
These attacks had a periodicity, occurring every two or three days. 
Under the use of elixir of cinchona to the child and quinine to the 
mother, the attacks ceased. Dr. R. P. Harris related a similar case. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

According to these authors, children, even at a very early age, bear 
full doses of quinia very well. The amount which they have usually 
found necessary to arrest an attack of intermittent fever is three grains 
daily for children of one year of age or under, and one grain additional 
for each succeeding year, though they have given as mucrj as five grains 
by the mouth in the course of the day to children of tefi months, and 
without the slightest ill effect. It may be administered in the form of 
powders, containing one-half grain, mixed with an equal amount of sugar 
and powdered extract of liquorice, repeated as necessarV, and given at 
such times as to bring the system thoroughly under the 
druo\ before the hour at which the accession of the 
noticed. Some children, however, will not take the pbwders without 
difficulty or nausea, and the quinia may then be given sitoply suspended 
in syrup of liquorice or in the following combination. 

266. R. Quinise sulph., gr. xxiv 

Acid, sulph. diluti., gtt. xxx 

Syr. zingiberis, 

Syr. simplicis, 

Aquse, aa f. gj. M. 

Ft. sol., 
S. — Teaspocmful three or four times a day, according to age. 

If, however, the stomach rejects it in all of these forajs, the adminis- 
tration by enema of two grains of quinia in a tablespoi>nful of starch 
water, three times a day, will be equally successful. We may also re- 



nfluence of the 
ever has been 



MALARIA. 233 

sort to the use of suppositories, which, when neatly made with the 
butter of cacao and of small size are perfectly well tolerated, as a rule, 
even by very young infants. A small amount of dilute sulphuric acid, 
about one- half of a drop to each grain should be added to the quinia in 
either of these modes of administration to favor its solubility and 
absorption. 

In ordinary acute cases, no other treatment is required. It may be 
well to give a few doses of some saline febrifuge each day, until the 
fever is entirely subdued, and, of course, any special disturbance of 
function must be relieved by appropriate remedies. The treatment of 
pulmonary complication must be subordinate to that of the general 
disease. All depleting or perturbing treatment must be avoided, and 
it will generally be found that with the aid of mild counter-irritation, 
the local symptoms will begin to improve, after the malarial fever has 
been subdued by quinia. It is necessary to keep up the action of quinia 
for some time after the paroxysms are broken, because the tendency for 
the disease to recur is fully as great in children as in adults. Our 
authors are in the habit of continuing it for three or four weeks, in 
diminished doses, giving, however, on each septenary period, dating 
from the arrest of the paroxysms, the full antiperiodic dose, suited to 
the age of the patient. 

At the same time the child should take suitable doses of iron and 
arsenic, which may be conveniently given in the following form : 

267. R . Liq. potassii arsenitis, f. ,\j 

Vin. ferri Amari, f. Sjiij. M. 

S. — From a half to a whole teaspoonful thrice daily, in water, after meals. 

In chronic malaria, we must persist in the use of quinia, iron and 
arsenic for a considerable period. At the same time careful attention 
must be paid to securing the best possible hygienic influences for the 
child. When practicable, a change of climate should be secured by a 
journey to the mountains or the sea-shore. The patient should be 
warmly dressed and carefully guarded against all exposure to damp or 
cold. The diet should be carefully selected and every error of diges- 
tion promptly corrected. Even after the child is apparently restored 
to health, it should not be allowed to return to the locality where it 
contracted the disease, and for several successive springs and autumns 
should take a short course of quinia and arsenic. In the treatment of 
enlargement of the spleen, which frequently occurs in chronic malaria, 



234 DISEASES OF CHILDREN. 

our authors have obtained excellent results from the use of hypodermic 
injections of ergotin into the subcutaneous tissue of the abdominal wall. 

DR. HOLT. 

In the American Journal of Obstetrics, for 1884, this author tells 
us that malaria in early life presents symptoms peculiar to that period, 
and differs from the same disease in adults as widely as does pneu- 
monia. In any acute febrile disease, presenting an unusual course, the 
spleen should always be examined. It may be the cause of obstinate 
cases of diarrhoea or bronchitis, not affected by ordinary remedies, 
especially if these symptoms show a tendency to periodicity. Spells 
of drowsiness and frequent attacks of epigastric pains should always 
excite suspicion. 



MEL^NA NEONATORUM. 

DR. EDWARD HENOCH, OF BERLIN. 

This disease, which is not common, is characterized by hemorrhages 
from the stomach and bowels, usually from the first to the seventh day 
after birth, rarely later. Recovery may occur though the hemorrhage 
has been profuse enough to cause symptoms of collapse, general cold- 
ness, disappearance of the pulse, and upturning of the eyeballs. He 
always endeavors, therefore to check the hemorrhage, even under the 
most unfavorable circumstances. The application of cold fomentations 
or an ice bag to the abdomen, and warm flannel to the arms and legs is 
to be especially commended. If the children cannot take the breast, 
milk, cooled in ice, should be given by the spoon. Liquor ferri 
sesquichlor. (one drop every two hours in a teaspoonful of oat-meal 
gruel) should be given. With regard to prophylaxis, he warns against 
the too early ligature of the umbilical cord, which should only be per- 
formed after respiration has been thoroughly performed and vigorous 
cries have been uttered. 



MENINGITIS — ACUTE. . 235 



MENINGITIS-ACUTE. 

DR. WILLIAM T. PLANT, OF NEW YORK. 

This author considers that if you are clever enough to recognize the 
disease at its invasion, there is some little hope (iV. Y. Medical Jour- 
nal^ 1883). The child should be kept quiet in a darkened room, and 
spared all causes of annoyance and worriment. The diet should be as 
nutritious as the child will take. Milk, cream and meat broths are best. 
A hot mustard foot-bath lessens the crebral congestion and soothes the 
child. It may be used as often as four or five times in the twenty-four 
hours. Keep the feet and legs warm by bottles of hot water or other 
means. If there is a heavy growth of hair, it should be thinned, and 
cloths, not too thick, wrung from iced water and changed often, so as to 
make constant impression of cold, may be laid upon the head. When 
there is intense heat of head, bladders of pounded ice may be applied, 
some layers of cloth coming between the ice and the scalp. Correct 
constipation by an agreeable laxative, but beware of hypercatharsis. 
Iodide of potassium is the only drug that has any effect. It should be 
early and continuously given in doses of from two to five grains. To 
relieve the headache and ward off convulsions, bromide of potassium is 
the best remedy. When there is great restlessness chloral may be com- 
bined with the bromide. Give them boldly, until the purpose is effected. 
Valerian tends to quiet muscular twitching. It is better to dispense 
with opium, but in some cases the agony is so great, that hypodermics 
of morphia must be given. A child with inherited tuberculous or scro- 
fulous tendencies should be well looked after, especially if it begins to 
exhibit those vague but growing evidences of poorliness, that are so 
often precursory to this affection. Cod-liver oil should be given, a half 
teaspoonful or more ter die. Stimulants are in order — Bourbon or 
brandy with milk. If there are moist eruptions about the head and 
face, he would not attempt to dry them by local applications, but rather 
trust them to disappear with the improvement in the general condition. 

M. VOVARD, OF BORDEAUX. 

According to this author (Gazette des Hopitaux, 1883,) the fol- 
lowing method of treatment has yielded good results, in cases that are 
not complicated with tuberculosis : The child's head is shaved, and a 
thin layer of croton oil is spread over the scalp with a soft brush, after 



Zob DISEASES OF CHILDREN. 

which the head is covered with a linen cap. This procedure is re- 
peated three times daily until an abundant pustular eruption results. 
Next, beet-root leaves are sewed into a small hood with which the head 
is covered, this also being done two or three times a day. At the same 
time iodide of potash is given in reasonable doses. The result of this 
treatment will depend upon the extent and duration of suppuration. 
The author saved eleven out of thirty cases by this method. 



According to this author, antiphlogosis plays the principal part in 
the treatment of meningitis. Even here many authors dread bleeding, 
but this must be regarded as a grave sin of omission. The bleeding 
must be regulated by the general condition of the patient. In small, 
poorly nourished, anaemic children, two to four leeches should be ap- 
plied, according to the age of the patient, and the bites should not be 
allowed to bleed afterwards. In older children, especially if robust, 
six to ten leeches, or an equal number of wet cups, to the neck or spine 
are requisite. So long as symptoms of collapse are absent, an ice-bag 
should be constantly applied to the head, inunctions of ung. ciner. 
mercur., every three hours, applied to the neck, back, arms and legs, 
and calomel given internally (gr. i-ss every two hours). When there 
is great restlessness or convulsions, he resorts to injections of morphia 
or chloral hydrate, and also to lukewarm baths, with cold affusions to 
the head. He always uses iodide of potassium after the termination of 
the acute stage. 

268. R. Potass, iodid., gr. xv-xxx 

Aq. destil., f«S"J 

Aq. mentli. pip., f-5 v - M. 

S. — Dessertspoonful three or four times a day. 

During the continued use of this remedy, he has frequently seen 
children gradually awake from the comatose state, the contractures dis- 
appear and complete recovery finally occurs. 

DR. J. CHEWNING, OF ILLINOIS, 

Reports good results from the use of salicylic acid (Medical and Sur- 
gical Reporter, 1884). He uses it in doses of from ten to twenty 
grains every six hours. Dr. D. C. Ramsey also recommends it very 
highly. 



MENINGITIS-ACUTE. 237 



Our authors think it must be evident that but little dependence can 
or ought to be placed on any but prompt and powerful antiphlogistic 
treatment. Depletion, therefore, mercury, cold applications to the 
head, laxatives, counter-irritants, and the most rigid diet, ought to be 
employed from as early a period as possible. If there is any case, ex- 
cepting those in which venesection is indicated for the relief of mechan- 
ical engorgement of the right heart, when general bleeding would 
appear to be preferable to local depletion, acute simple meningitis in a 
vigorous child may be cited to be such. The amount of blood to be 
drawn must depend upon the age and constitution of the subject, and 
the violence of the attack, in some measure, though it should always 
be as much or more than is necessary in any of the other acute affec- 
tions of childhood. In a child two years old, of good constitution, 
from two to four ounces would not be too much at first ; and should the 
symptoms not moderate in six or eight hours, as much more may be 
taken. The application of cold to the head is another most efficient 
remedy. We may use a bladder, containing water and pounded ice, 
or cloths wrung out of ice-cold water. If there is reason to suspect 
undigested matter in the alimentary canal, we may give a dose of 
castor oil, citrate of magnesia or rhubarb. It is well to give calomel 
in small and frequently-repeated doses until the bowels are moved, and 
afterwards to continue it in still smaller doses, given at longer inter- 
vals, to secure its specific influence on the inflammation. Iodide of 
potassium should be given in full doses, as soon as the calomel is sus- 
pended, or from the beginning, in case this latter remedy is not em- 
ployed. Bromide of potassium and bromide of sodium, are the most 
valuable sedatives in the acute stage of this disease, when marked 
symptoms of cerebral excitement or a tendency to convulsions exist. 
The doses should be full and frequently repeated, as, for instance, at 
one year of age, from three to five grains every two or three hours. 

Counter-irritants are useful as adjuvants to the more powerful 
remedies already indicated. During the first day or two they should 
consist chiefly of sinapisms and mustard poultices, applied from time to 
time to the trunk and extremities. We should not use blisters until the 
active symptoms of the disease have been subdued. They may be 
applied to the head itself, to the nucha or to the extremities. 



238 DISEASES OF CHILDREN. 



MENINGITIS-TUBERCULAR. 

DR. EDWARD HENOCH, OF BERLIN. 

This author considers that all physicians who are conscientious in 
making a diagnosis, will regard every case of tubercular meningitis as 
lost. However, the possibility of recovery cannot be denied. In the 
first few days of the disease, he applies, according to age, from three 
to six leeches behind the ears and an ice bag to the head, giving calo- 
mel (gr. j every two hours) and compound infusion of senna, if the 
evacuations are not profuse, and orders inunctions of unguent, ciner. on 
the throat and neck a couple of times a day. Although we can hope 
for success from this treatment in only very exceptional cases, it cannot 
prove injurious in a disease which always proves fatal when left to 
itself. If not adopted in the first few days of the disease, all methods 
are useless. 

DR. HENRY GREENWAY, OF ENGLAND. 

This author has found (British Medical Journal, 1884,) that phos- 
phorus seems to have some control over tubercular meningitis. He used 
Fauconnet's syrup of phosphorus, a French preparation. For children, 
he prescribes from one to two minim doses of the phosphorus-syrup for 
each year of age, the dose to be repeated every four hours whilst nec- 
essary. The drug should be dispensed, mixed with simple syrup, so 
that a teaspoonful shall contain the required dose. This should be 
afterwards diluted with water if the proportion of the drug be large. 
He supposes that certain other preparations of phosphorus would prove 
equally useful. He has not had occasion to treat an adult for this 
affection, but thinks the dose for such patient should not exceed thirty 
minims of the drug. Perhaps less would suffice. 

DR. CHARLES W. EARLE, OF ILLINOIS. 

In the Chicago Medical Journal and Examiner, 1879, this author 
very truly says that in almost every case in which the disease is fully 
developed, death is the final result, and only in prophylaxis can a phy- 
sician obtain any results at all satisfactory. The presence of the tuber- 
cular or scrofulous diathesis may in a great number of cases be removed, 
if one could but have the hearty co-operation of the parents. Mothers 
with this peculiarity should be informed in regard to the probable taint 






MENINGITIS TUBERCULAR. 239 

they are to communicate to their offspring, and everything in the way 
of nourishment and nutritious medicaments should be administered. 
It is quite possible that such mothers should not be allowed to nurse 
their children, although he is always unwilling to deprive any child 
under the year of its proper maternal food — " a food for which nature 
does not afford, nor can art supply a substitute " — unless there is some 
grave reason for such deprivation. Children in whom there is the 
faintest possibility of such a taint, should be given the benefit of the 
country air, if possible — good hygienic surroundings, perfect nutrition 
— especially a sufficient dietary, for, in this blessed land of ours, chil- 
dren do starve to death. Diseases which produce a tendency to the 
diathesis, should be prevented by avoiding the opportunities of receiv- 
ing the contagion into the system. It is wholly impossible to prevent 
all children from coming in contact with whooping cough, measles, 
diphtheria, and the like; but there is no reason why the effort should 
not be nride with this peculiar class of children. 

They should have the benefit of cod-liver oil and syrup of the iodide 
of iron — the malt and hypophosphate preparations. Above all we 
should not, because a child is slightly tubercular or scrofulous, despair 
of either staying the disease or of ultimately restoring to the anxious 
parents a healthy and robust child. The hopeless pathology of fifty- 
years ago, indeed, gave no hope, but more recent conclusions give a 
brighter future. While it is doubtful if tubercle in the brain is ever 
cured, it has been abundantly shown by Niemeyer and others that in 
other parts of the body it is amenable to treatment, and that by several 
modes recovery does take place. 

PROPHYLACTIC TREATMENT. 
DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

Our authors consider that it must be evident that the prophylactic 
treatment is of special importance in a disease so little amenable to 
curative measures. When, therefore, there is reason to suspect a ten- 
dency to tubercular meningitis in a child, either from the fact that 
other children in the family have perished from it, or from a bad state 
of the general health, and frequent complaints of headache, it becomes 
proper and necessary to regulate both the moral and physical education 
with a view to its prevention. For this end the hygienic management 
of the child ought to be such as is best calculated to prevent the for- 



240 DISEASES OF CHILDREN. 

mation or development of tubercles in the constitution. During 
infancy, such a child should be nursed, if this be possible, by a strong, 
hearty woman, with an abundant flow of milk. If the mother is not 
possessed of these qualities — if there be, indeed, the least doubt upon 
the point — she ought to give up nursing herself and procure a wet nurse 
of the kind described. This alone will, in all probability, often make 
a difference between a vigorous and a fragile constitution. When the 
time for weaning arrives, the change ought to be made with the greatest 
care and circumspection. During and for some time after weaning, the 
diet must consist principally of milk preparations and bread, and of 
small quantities of light broths, or of meat very finely cut up. As the 
child grows older, the meals ought to be arranged at regular hours, 
and should consist of four in the day. The principal food must be 
bread and milk, well chosen, well-cooked meats, and rice and potatoes 
as almost the only vegetables. After the first dentition is completed, 
a moderate use of ripe and wholesome fruits may be allowed, but 
always with care, in order to avoid injury to the digestive organs, and 
also so as not to mar the appetite for more wholesome and .nutritious 
food. Coffee and teas ought to be forbidden at all times ; since, when 
the palate of a child, is taught, by habit, to become accustomed to these 
more highly sapid substances, it is very apt to abandon the use of milk, 
which ought to constitute a very large proportion of its food, at least 
up to the age of twelve or fifteen years. The child should not taste 
improper articles of food, so that it may escape the torment of desiring 
what is improper. 

After diet, the most important points in the treatment are air and 
clothing. The child should inhabit, if possible, a large, dry, well ven- 
tilated room, which ought to be kept as cool as possible in summer, and 
moderately warm in winter. Not a day should be allowed to pass, 
unless the weather is totally unfit, without the child's being sent for 
several hours into the open air. The clothing should be cool in sum- 
mer and warm in winter. In our country there is a great inclination to 
harden children by dressing them very slightly in cold weather ; so 
that they frequently suffer from catarrh, pneumonia, and spasmodic 
croup brought on by improper exposure. This cannot but be wrong in 
a child who shows the least evidence of tendency to tubercular affec- 
tions. Our authors, from their own experience, are fully convinced 
that by far the most certain and effectual means of preventing the de- 



MENINGITIS — TUBERCULAR. 241 

velopment of a tubercular, or indeed any other cachexia in a child, is to 
have it brought up in the open country, or in some healthy village, 
until the epoch of puberty has passed by safely. A very good plan for 
parents whose occupations compel them to live in cities or large towns, 
is to have their residence a few miles in the country, and to come to 
town every day. Children brought up in this w T ay have a far better 
chance of obtaining strong and vigorous constitutions, than those reared 
entirely in the close and confined dwellings and streets of crowded 
cities. 

When a child who, from the health of its parents, or from its own 
appearance, may be suspected of having any tubercular or scrofulous 
taint in its system, becomes subject to frequent attacks of apparently 
causeless headache, and especially when such headaches are associated 
with a constipated habit of body and with occasional vomiting, it ought 
to be looked upon as threatened with tubercular disease of the brain. 
Under these circumstances, in addition to the precautions already re- 
commended, our authors advise that the child be at once put upon the 
use of cod-liver oil, iodide of iron and mild laxatives, and that these be 
persevered in for several weeks or months, until, in fact, the strength and 
general health are restored and the headaches cease. When the 
appetite is poor, and the digestion is imperfect, in such a case, we may 
use with advantage, besides the above remedies, solution of pepsin, a 
teaspoonful three times a day with the meals, or tincture of nux vomica, 
three or four drops in a mixture of syrup and compound tincture of 
gentian, or in a teaspoonful of elixir of cinchona three times a day. If 
the child is of an age to be going on with its education, this should for 
the time cease, or be carried on in such a way as to avoid all excitement 
and fatigue. If in any child whose hereditary tendencies or w T hose 
physical characteristics are such as to make us fear a predisposition to 
tuberculosis, there should also be evidences of marked nervous irritabil- 
ity or precocious mental development, it is desirable to use every means 
to prevent a continuance of such undue cerebral activity, which might 
tend to induce tuberculosis of that organ or its membranes. We must 
however, for the most part, be satisfied with a careful atttention to all 
the details of hygiene, in addition to which, however, the following 
points deserve mention, viz., to keep the head cool, by not allowing it. 
to be too warmly covered, and by keeping the hair short ; to keep the 
extremities warm ; and to avoid stimulating the intellectual faculties to 
16 



242 DISEASES OF CHILDREN. 

any considerable extent by education, until after eight or ten years of 
age. If, finally, in such children, there should be extensive eruptions 
on the scalp, it may be safe to undertake their cure by suitable internal 
remedies and mild external applications, rather than to try by powerful 
local treatment to rapidly remove the affection of the skin. 



NOMA PUDENDI. 



DR. PUREFOY, OF IRELAND. 

This author considers that noma pudendi is identical with cancrum 
oris, the only difference being in its situation. In the early stages he 
applies warm bread poultices, and subsequently carbolic oil (1 in 40) 
dressings, aided by constitutional treatment. 



(ESOPHAGUS : FOREIGN BODIES IN. 

DR. LANNELONGUE, OF FRANCE. 

On account of the practice, so common among children, of putting 
different articles into the mouth, it not infrequently happens, that by 
accident they slip or are drawn into the oesophagus. Our author, in a 
communication to the Societe de Chirurgie of Paris, 1880, tells us 
that he has extracted foreign bodies from the oesophagus eighteen times, 
in children from eighteen months to six and a half years of age. In 
thirteen instances these were pieces of money, and in most of the 
others the articles came from toy houses. Children to whom this acci- 
dent occurs do not usually own it, for fear of being scolded, and it is 
only when unpleasant symptoms occur that they complain. These 
symptoms generally consist in difficulty of swallowing, pain, with dis- 
turbances of respiration and phonation, often of reflex origin. Some 
time usually elapses before the child is brought to the surgeon, who 
has first to assure himself whether a foreign body is really present. 
He explores the pharynx first by his finger, then with an olivary sound, 
the action of this latter against the foreign body being often unper- 
ceived in consequence of the latter becoming surrounded by mucus and 



OPHTHALMIA NEONATORUM. ; 243 

fragments of food. For this reason Graefe's basket is often more use- 
ful, as it may succeed in catching the body, although no friction with 
this has been felt. All the pieces of money in the thirteen cases were 
fished up by its aid. In one of the cases a miniature flask of curacoa 
could be felt by the sound, but was not extracted for fear of breaking, 
and at the end of three days it was passed per anum. 



OPHTHALMIA NEONATORUM. 

DR. COLSMAN, OF BARMEN. 

This author (Lancet, 1882,) says that this disease is very prevalent 
among the offspring of the lower classes of the -population, on account 
of the eyes receiving, at birth, the contact of contagious substance, the 
sources of which are abundant among this class. With the view of 
preventing the outbreak of the disorder, he recommends dropping into 
the eyes, immediately after birth, a two per cent, solution of carbolic 
acid or nitrate of silver, with fomentations of a solution of salicylic 
acid during the first twenty -four hours. 



M. Galezowski's treatment consists in simply touching the conjunc- 
tiva with the following solution, using a camel's-hair brush for the pur- 
pose : 

269. R. Argenti nitrat., gr. x 

Aquae destil., gj. M. 

After touching with this solution, another pencil dipped in a solution 
of common salt should be passed over the parts, to neutralize the excess 
of the silver salt. Such is the method exclusively employed by M. 
Galezowski in his ophthalmological clinic at Paris ; he uses no other 
means against excessive suppuration, intense chemosis or ulceration of 
the cornea, if they occur. , And yet, out of 4,000 cases treated in his 
service, not one eye was lost. Treated in this manner, the malady re- 
quires from five to six weeks for complete cure. 

DR. BULL, OF NEW YORK. 

The prophylactic measures recommended by this author (iV. Y. 



244 DISEASES OF CHILDREN. 

Medical Journal, 1881,) are as follows: In all cases of paginal dis 
charge in parturient women, whether specific or not, the vagina should 
be carefully cleansed and disinfected repeatedly before parturition be- 
gins. As soon as the child is born the external surface and edges of 
the eyelids should be carefully cleansed with a one or two per cent, 
solution of carbolic acid, and then the conjunctival cul-de-sac washed 
out with some of the same solution, or with a saturated solution of 
boracic acid. This must be done by the attending physician, or by a 
skilled nurse under his supervision. The eyes of all newborn children 
should be carefully watched for the first week or ten days, and when- 
ever any signs of an ordinary catarrhal conjunctivitis appear, the con- 
junctiva should be thoroughly brushed over with a solution of nitrate 
of silver, from two to five grains to the ounce of water. If the con- 
junctivitis has become purulent, and the case is one of real ophthalmia 
neonatorum, the child should, if possible, be isolated from all healthy 
infants, and have its own bath-tub. If this is not possible the diseased 
infant should be bathed last, and no sponges should be used, but only 
cloths, which can afterward be destroyed. If one eye only is affected, 
do not apply the hermetically-sealed bandage to the sound eye, but 
envelop the arms or hands of the baby, so as to prevent the secretion 
from being carried to the fellow eye,. and lay the child upon the side 
corresponding to the diseased eye. 

The most important feature in the treatment is enforced cleanliness. 
This requires constant attention, and the frequent use of some soft cloths 
and plenty of water. The use of cold cloths, dipped in cold water or 
even iced water, and laid on the eyelids, must be regulated by the 
amount of swelling of the lids and heat of the parts. As soon as the 
lids can be everted, the proper treatment is a thorough application of 
nitrate of silver to the conjunctiva of the lid and retrotarsal fold, daily, 
and sometimes twice a day. If this is thoroughly done, a five-grain 
solution will in most cases suffice ; but where there are profuse secre- 
tion and considerable swelling of the conjunctiva, a ten-grain solution 
becomes necessary. When, owing to marked hypertrophy of the papil- 
lary structure of the conjunctiva, a stronger caustic becomes necessary, 
it is better to discard solutions, and employ the lapis mitigatus (one 
part nitrate of silver to two parts of nitrate potassium), and neutralize 
its effect by a subsequent, washing with a solution of common salt. It 
is well to employ a one-grain solution of sulphate of atropia in a satu- 



PAROTITIS, OR MUMPS. 245 

rated solution of boracic acid in every case of purulent ophthalmia, as 
the great danger in this disease is purulent infiltration and perforation 
of the cornea. Should this infiltration occur at the centre of the cornea, 
the atropia should be instilled frequently ; for, if perforation occurs, the 
dilatation of the pupil will prevent a large prolapse of the iris through 
the perforation. If the infiltration of the cornea, on the contrary, be at 
or near the margin, it is better to employ a two-grain solution of the 
sulphate of eserine, as thus an extensive prolapse of the iris may be pre- 
vented if the ulcer perforate. In all cases the cleansing and washing of 
the lids and conjunctiva should be done with a saturated solution of 
boracic acid, and the atropine and eserine should be dissolved in the 
same. 



PAROTITIS, OR MUMPS. 

EDWARD ELLIS, M. D., LONDON. 

The swelling of the parotid gland should be fomented several times a 
day, with a flannel wrung out in a hot lotion containing an opiate, and a 
linseed-meel poultice applied occasionally. The bowels must be kept 
open by laxatives. 

Should there be metastasis to the brain, a few leeches may be applied 
to the temples, the feet should be immersed in hot mustard-water, and 
a brisk aperient given every three or four hours. Metastasis to the 
testicles or mammae requires fomentations and the same general treat- 
ment in the way of purgatives and derivatives. 

When the parotitis occurs in the course of measles or scarlatina, it is 
usually significant of an adynamic condition, and requires supporting 
and stimulant medication. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

As mumps almost invariably runs a favorable course, the treatment 
should be of a mild and expectant character. The child should be 
strictly confined to bed ; the diet should be fluid, partly on account of 
the great difficulty in mastication, light and digestible, consisting chiefly 
of preparations of milk and light animal broths. The only internal 
remedies required are febrifuges, such as spirits of nitrous ether, and 
solution of acetate of ammonia, with a free supply of water and acidu- 



246 DISEASES OF CHILDREN. 

lated drinks ; occasional laxatives ; and, if there is sleeplessness, small 
doses of Dover's powder or some other anodyne. Local applications 
appear to have little or no influence upon the course of the swelling. 
The only ones to be recommended are warm, light poultices, or light 
water dressings, covered with oiled silk, which do not annoy the child 
and tend to favor resolution. If the induration be marked and exten- 
sive, so as to threaten suppuration, it has been advised to apply a few 
leeches behind the angle of the jaw. If it should become evident that 
suppuration has occurred, the abscess should be opened immediately, 
and the discharge favored by the application of poultices, in order to 
prevent further destruction of the gland or perforation of the external 
auditory meatus. In cases where induration and enlargement of the 
gland persist, absorbent applications, such as inunctions of iodine or 
mercury, should be made over the tumor. In cases where alarming 
symptoms of depression and cerebral disturbance make their appearance 
after the sudden subsidence of the parotid swelling, the effort may be 
made to redevelop the external inflammation by stimulating applications 
to the surface, and by the internal administration of nervous and diffusi- 
ble stimulants, such as ammonia, musk or brandy. 

After the acute symptoms of the attack have subsided, and the child 
has fully entered upon convalescence, we would caution against allowing 
it to leave bed too soon, since we have occasionally observed such pre- 
mature exposure to be followed by marked febrile sequelae. Thus, in 
one case, occurring in an adult, there was marked fever lasting for a 
week ; in another case, in a child, there was high fever for ten days ; 
and in a third case, also in a child, there was most obstinate and violent 
vomiting for four days. 



PAYOR NOCTURNUS (NIGHT TERRORS). 

DR. EDWARD HENOCH, OF BERLIN. 

This author would not hesitate to use morphia or chloral in very 
severe cases. He differs from West, that nocturnal terrors are caused 
usually by disturbances of digestion. He has rarely, with any cer- 
tainty, detected dyspeptic symptoms, whose removal relieved the affec- 
tion. Hence he confines his treatment to the prohibition of any stimu- 



PAVOR NOCTURNUS (NIGHT TERRORS.) 247 

lation of the youthful imagination by the recital of tales at night, and 
to the administration before retiring of a dose of bromide of potassium. 

PROFESSOR WILLIAM PEPPER, OF PHILADELPHIA. 

When, as sometimes happens, we find in these cases of "Night 
Terrors," a history of long continued irritation of the stomach and 
bowels, an exaggerated sensibility of the nervous system, and a defec- 
tive state of nutrition, this author would give {Medical and Surgical 
Reporter, 1882,) a teaspoonful of an emulsion of cod liver oil with the 
hypophosphites, after meals. He would then use one or two sorts of 
remedies : either remedies directed to the nervous system — and of 
these he would select one or two, either the bromides, by the mouth, or 
quinine and assafoetida, by the rectum : he would use a suppository, 
containing : 

270. H. Quinise sulphatis, 

Assafoetida. aa gr.jss; 

Or, if this irritates the bowels, it would have to be omitted, and he 
would give : 

271. R. Potassii bromidi, 

Sodii bromidi, aa gr. jss, 

In a little calisaya elixir three times a day, between meals — or, in the 
second place, if he found, under close observation, that digestion was 
not right, that the stools were broken, irregular in color, and imper- 
fectly digested, and that there was a good deal of flatulent distention 
of the bowel, he should not give the remedies above mentioned, unless, 
perhaps, a little quinine and assafoetida at night, but he would give 
remedies directed to the mucous membrane of the stomach and bowels. 
These would be either pepsin and bismuth, or oxide of silver. This is 
the class of cases, either of spasmodic nervous trouble or of epilepsy 
associated with gastro-intestinal irritability, where the salts of silver 
have earned their reputation ; nitrate of silver is considered by the laity 
as one of the most reliable remedies in the treatment of epilepsy. 
Nearly all the cases, if not all, that have been cured by this drug, have 
been cases in which the attacks have been reflex from irritation of the 
gastro-intestinal mucous membrane. If, on careful examination, there 
are evidences of a long- continued subacute irritation of the stomach and 
bowels, he should give from one-twelfth to one-eighth of a grain of oxide 



248 DISEASES OF CHILDREN. 

of silver in a small pill, or else one twenty-fourth grain of nitrate of 
silver in solution. With this he should give the cod-liver oil, regulate 
the diet, keep him where he would not be frightened by the cars, and 
be very careful that he did not get over-fatigued or excited. 

DR. WILLIAM B. ATKINSON, OF PHILADELPHIA. 

This author says that the treatment must be directed to the avoidance 
of the causes, (Alienist and Neurologist, 1884,) as fright, silly-shines, 
sleeping without a light, injudicious feeding, the relief of constipation, 
the use of abundance of fresh air and exercise ; the latter, even to the 
point of approaching fatigue, so that the child may sleep soundly, 
without dreaming ; and the employment of nervines and tonics, prefer- 
ably those containing phosphorus and. iron. 



DR. MOIZARD, OF FRANCE. 

According to this author (Revue des Malades de V Enfance, 1884), 
the preponderating influence of digestive troubles indicate the necessity 
of a rigid diet. Intellectual hygiene is of no less importance, and any 
excess of mental work should be strictly avoided. As children of deli- 
cate complexion are often involved, regular exercise and a regime, both 
restorative, and tonic are necessary. As to the paroxysm itself, 
bromide of potassium and chloral appear to be the best remedies indi- 
cated. It should be remembered that these attacks almost invariably 
supervene in the first part of the night, and they should, therefore, be 
guarded against and prevented "by securing a sound and quiet sleep 
during the first three or four hours of the night. 

DR. HARKIN, OF IRELAND. 

This teacher tells us in the Dublin Medical Journal, 1880, that 
young children from the first to the sixth year, particularly those sleep- 
ing in over-crowded rooms, are subject to frequent attacks of scream- 
ing at night, with insensibility and semi-convulsions, and somnambulism, 
if not watched, and something approaching to the 'petit mal, due to the 
protracted inhalation of air deficient in oxygen, and laden with carbonic 
acid and other morbid products, a persistence in this habit often lead- 
ing to tubercle of the brain or lungs. For this condition he has always 
found the chlorate of potassium a sovereign remedy. 



PEMPHIGUS NEONATORUM — PERITONITIS. 249 

PEMPHIGUS NEONATORUM. 

DR. EDWARD HENOCH, OF BERLIN. 

General tonic treatment is indicated, especially breast milk, wine 
and good air. Baths of corrosive sublimate (15 grs. to the bath) 
should be used when there are positive evidences of syphilis. 



PERITONITIS. 



DR. OSCAR SILBERMANN, OF GERMANY. 

In Jlirbch.f. KindJilkde, 1882, this author says that peritonitis in 
infancy is not marked by the clear and characteristic symptoms which 
it presents in adult life. Of 186 cases in the first year of life, 102 
were in the first two weeks, and 62 in the next two. There are two 
varieties: 1. A non-septic (chronic) form, and 2. A septic (acute) 
form. 

The non-septic form develops usually early in foetal life, and its most 
important cause is undoubtedly syphilis. The children are either born 
dead and often partially macerated, or they die shortly after birth with 
symptoms of marasmus. In the latter case the striking appearances 
are the aged face and drawn and decrepit appearance, the distended 
abdomen, more or less ascites, spleen and liver enlarged, respiration 
rapid and pulse small, extremities cool, cyanosis. It is, however, not 
always limited to these symptoms, but often by involving the intestines 
and their coverings leads to atresia ani, and sometimes stenosis or com- 
plete atresia of the small intestines. The author reports an interesting 
case of this latter kind. 

In considering the septic or acute form, the author makes a further 
subdivision into two classes, both of which usually depend on infection 
through the navel. The first is general septicaemia, of which the peri- 
tonitis is only one symptom. The other is peritonitis appearing as the 
single and only effect of septic infection, and characterized by clear 
features. In the midst of apparent health, the children become rest- 
less, cry, refuse the breast, begin to fall away, and the pulse and res- 
piration rapidly increase. The prodromal appearances may, however, 
be wanting, and then we have at once vomiting, sharp diarrhoea, mete- 



250 DISEASES OF CHILDREN. 

orismus, tenderness of the abdomen, frequent respiration, very rapid 
pulse and intense icterus. After a few days, or even hours, the ex- 
tremities become cold, the pulse small and imperceptible, and the child 
dies in collapse. In some cases the symptoms are less stormy, and pass 
over in a few days (Quinquaud's "abortive form"). With such clear 
symptoms, with septic disease of the mother or septic appearance of the 
navel, it would seem that there could scarcely be any difficulty of diag- 
nosis ; the author, however, takes up the separate symptoms, and shows 
that hardly one of them is constant. The vomiting may be absent, 
there may be constipation instead of diarrhoea, meteorismus occasionally 
is wanting ; exudation is always present, but is sometimes so slight that 
especially if there is meteorismus, it cannot be detected; tenderness of 
the abdomen occurs in other diseases also, pulse, temperature, and res- 
piration may offer the same variations from other causes, etc., etc. 
The rapid loss of weight is one of the most unfailing symptoms. The 
only other disease which causes this so rapidly is a severe dyspepsia, 
with which in fact a peritonitis is most likely to be confounded, espe- 
cially if it occur late, after the umbilical wound is closed. 

The treatment of septic peritonitis is first of all prophylactic. The 
umbilical wound must be kept perfectly clean, and the child removed 
from the mother if she shows any signs of septic trouble. For the high 
fever, quinine and Priessnitz' compresses — never salicylic acid, which 
may cause severe collapse. For the vomiting, chloral hydrate. 

272. R . Chloral hydrat, gr. xv-xxx 

Aquse, f. ^ iij . M. 

S . — Teaspoonful hourly. 

To keep up the strength, stimulants are necessary, and the author 
especially recommends green tea and rum-water, which is often well 
borne when every other drink, and especially wine, is constantly vomited. 
Opium and cold are contraindicated, as causing collapse. The prog- 
nosis is bad, but this must not deter us from using every means at hand. 



PERTUSSIS. 



DR. ARM AND SEMPLE, OF LONDON. 

This author very truly says that the treatment of whooping-cough 



PERTUSSIS. 251 

cannot be considered as satisfactory. After enumerating the various 
classes of remedies that have been recommended, he says that it may 
be stated in general terms that in uncomplicated cases of whooping- 
cough it will be useful to administer in the first place some mild altera- 
tives and antacids, as hydrargyrum cum creta, soda, potash, and 
rhubarb, together with ipecacuanha in moderate and long continued 
doses (5-10 minims according to the age). In general the disease 
lasts, in spite of all remedies, from a month to six weeks ; but it may 
last much longer, in which case, change of air will be found the most 
efficacious remedy, and not merely from an unhealthy to a healthy 
locality, but vice versa. It has been proposed and successfully carried 
out, to take sufferers from whooping-cough to the neighborhood of gas 
works, the effluvia from which appear to exercise a beneficial influence 
over the disease. When pertussis is complicated, as it often is, with 
other affections, the appropriate remedies must be employed. Thus in 
the strumous diathesis, cod-liver oil and iron will be indicated. 

DR. EDWARD HENOCH, OF BERLIN, 

Tells us that he has come to rely upon one drug alone, viz. morphine, 
which can at least moderate the violent paroxysms, especially the noc- 
turnal ones, and diminish their frequency, although it does not influ- 
ence the course of the disease on the whole. 

273. R • Morphise acet. vel. muriat., gr. $■-% 

Aquae destil., f.gj 

Syrup, f.3 h J- M - 

S. — Teaspoonful two or three times daily. 

We should be careful to warn the mothers, that as soon as unusual 
drowsiness develops, the remedy should Le at once discontinued. When 
carefully administered he has never seen any bad results follow, even 
when one or two teaspoonfuls of the mixture were given daily for 
weeks ; he therefore prefers it to all other narcotics, especially to the 
dangerous atropine. But he would recommend morphine only in severe 
cases, where at least twenty paroxysms occur in the twenty-four hours. 
He sometimes uses inhalations of carbolic acid, combined with the 
morphine. From them he has sometimes had good results, sometimes 
none at all, but he has never observed any bad effects. He uses 
either a one or two per cent, solution, by means of a spray apparatus ; 
if this is difficult of performance, the air of the room may be impreg- 



252 DISEASES OF CHILDREN. 

nated with its vapor, and a sponge, dipped in the solution, hung at the 
head of the bed, and a similar one held in front of the child's nose 
several times a day, so that its vapor can be inhaled for several minutes. 
In fine weather the fresh air should be enjoyed as much as possible ; 
but in rough, windy weather, or when severe bronchial catarrh is 
present, this should be strictly prohibited. His experience does not 
teach him that a change of air has any beneficial influence. 

DR. V. II . MOORE, OF ONTARIO. 

This author has been using croton-chloral hydrate for some years 
with great success (Medical and Surgical Reporter, 1884). In 
ninety-five per cent, of the cases in which he used it, the disease was 
cured in from six to twelve days. During the past five years he has 
attended two epidemics of pertussis, which gave him ample opportunity 
of testing the merits of croton-chloral in persons of almost all ages ; 
from infants under eight months, to persons of the age of fifty-five 
years. He found it act equally well, no matter what the age was. It 
must be given in full doses, properly dissolved, and every three hours. 
His method of prescribing it is as follows: For a child from eight to 
ten years of age : 

274. R. Croton-chloral hyd., ^iiss 

Aquae bullientis ad., f. ^ viij. M. 

Sig. — ^ss every three hours, night and day. 

The above dose, of course, should be increased or lessened, accord- 
ing to the strength and age of the patient. He does not use anything 
to cover the taste of the remedy, nor does he use anything to render it 
more soluble, experience having taught him that the best results were 
obtained when the remedy was given as above described. Croton- 
chloral has proved as sure a specific in his hands, in whooping-cough, 
as quinine has in intermittents. Let it be constantly borne in mind, 
that to get the beneficial effects of this drug, it must be given in full 
doses, properly dissolved, and every three hours. 

DR. MONCORVO, OF RIO DE JANEIRO. 

This author tells us, in the Allg. Med. Centr. Zeitung, 1884, that 
he has come to the following conclusions after careful study and much 
experience : 

1. Whooping-cough, the nature of which, until recently, was the sub- 



PERTUSSIS. 253 

ject of the greatest dispute, seems, to judge from the latest clinical 
observations and microscopical examinations, to belong to the zymotic 
diseases. 

2. The disease seems to be due to the presence of micrococci, which 
develop themselves to an alarming degree in the mucous membrane of 
that part of the larynx situated below the glottis, and infiltrate the 
epithelial cells. 

3. Resorcin, applied directly to the mucous membrane of the larynx, 
has not only diminished in a very short time the number of the attacks 
of coughing in cases in which it was employed, but it has also decidedly 
cut short the course of the malady. 

The best method of applying resorcin in these cases is its adminis- 
tration by an atomizer. If this cannot be had, it should be blown in 
the usual manner into the larynx by the aid of a quill. The only 
trouble is that whooping-cough is apt to attack young children, and that 
in them all direct applications to the larynx are difficult to execute. The 
internal administration of resorcin is, however, utterly useless. 

DR. ARCHAMBAULT, OF PARIS. 

This author recommends (Gaz. des Hopitaux, 1882, and Progres 
Medicale, 1882,) that children suffering from this disease should be 
kept in-doors and that special attention should be paid to keeping the 
temperature of the rooms they occupy uniform. He states that by 
means of such precautions, it is almost certain that such lung complica- 
tions as capillary bronchitis and broncho-pneumonia may be prevented. 
In support of his advice, he points to the fact that summer attacks of 
the disease are always milder than those in winter. The drug he re- 
commends is sulphate of atropine, 1-1000, one drop thrice daily for 
children a year old, two drops for two year old children and so on. 

DR. W. C. WEBB. 

This author has also had excellent results from the use of croton- 
chloral (see Dr. V, H. Moore, above) which he publishes in the 
American Practitioner, 1883. The lesson taught him by his exper- 
ience is to the effect that croton-chloral is, with very rare exceptions, 
singularly well borne by children. Next, that to get the full value of the 
drug it must be given in decided doses — doses large enough to produce 
quick and marked effect. A child twelve months old will bear a grain 
of the medicine every four hours, day and night, or six grains in the 



254 DISEASES OF CHILDREN. 

twenty -four hours ; and to get its curative effects, not less than this 
should be given. This during the first week. After that time the 
cough is usually so much relieved, that the number of doses may be 
lessened, the drug being given say during the day only. Used in this 
way, that is, pushed to its full effect, he has very seldom seen a case 
in which the cough was not under entire control within a fortnight. 
And he includes in this statement several excessively severe cases, 
complicated by convulsions and marked catarrhal difficulty. 

Children from ten to twelve years old will require two grains of 
cro ton-chloral at a dose, while an adult will not often bear more than 
four grains repeated^ as in the young child, every four hours. 

The drug does not disorder the digestive organs, and by lessening 
the frequency and severity of the paroxysms, puts an end to trouble- 
some hemorrhage and vomiting. Occasionally, the first few doses pro- 
duce some irritation about the throat and fauces, but this soon passes 
off. The toxic effects of the medicine do not seem to affect the organic 
centres. He has more than once seen patients fall asleep under its in- 
fluence while in their chairs, the respiration and movements of the 
heart remaining unchanged. 

Croton-chloral is readily dissolved in comp. tr. cardamoms, if first the 
drug be thoroughly pulverized. An eligible mixture is formed by dis- 
solving one drachm in two ounces each of tr. card, and glycerine. 

He has met with several cases in which the paroxysms of cough were 
so severe and accompanied by such extreme gastric irritability that it 
was necessary to give the patient a few whiffs of chloroform before 
attempting to administer the croton-chloral. He has seldom found it 
necessary to repeat the chloroform more than two or three times. In 
such cases as have used the anaesthetic, the very happiest effects have 
followed. 

Of the mixture mentioned, one drachm of croton-chloral and two 
ounces each of tr. card, and glycerine, the dose is a half-teaspoonful 
every four hours for a child two years old and under. 

Croton-chloral is so expensive a medicine that he has, owing to the 
known efficacy of belladonna in whooping-cough, sometimes used the 
following recipe, and with very good results: 

275. R. Croton-chloral, ffj 

Tr. cardam., ^ij 

Tr. belladon., £ij 

Glycerin., ^iij. M. 



PERTUSSIS. 255 

lie sometimes combines the several bromides with the croton-chloral, 
but never felt sure that they added in any degree to its efficacy. If 
one bromide was better than another, it was the bromide of quinia. 
Bui he relies now exclusively on the croton-chloral in the management 
of pertussis. While he has never seen any unpleasant effects from this 
drug, he adds that in its exhibition a watchful care should be exercised 
lest, for some reason, its toxic effects should manifest themselves. 



M. PIERRE VIGIER, OF FRANCE. 

M. Pierre Vigier, in a French journal, gives a few prescriptions. 
First, he recommends drosera to be given in the form of alcoholatc for 
a child one to two years of age, twenty drops three or four times a day 
in a little sweetened water; for older children, from one to four tea- 
Spoonfuls in the course of the day. The favorite remedy of Dr. 
Dedpech is one frequently employed in France, namely, thirty grains 
of powdered cochineal and twenty grains of sub carbonate of potash in 
balf a pint Of water, flavored and sweetened. M. VlGIER gives as a 
modication of this formula a recipe for a preparation which will keep, 
as follows : 

376. I£. Powdered cochineal, 3*U ! 

Subcarbonate of potash, jsiij 

Boiling w ater, Oj 

Sugar, g xxviij. 

Infuse the substances for half an hour, add the sugar, dissolve with 
a gentle heat, and strain. Children of one or two years may take two 
to three teaspoonfuls per day ; elder children, from three to six tca- 
SpOOnfulsj and adults, two tablespoonfuls per day. 

Dr.' Beauchene prescribes the following powder: 

277. R. Calcined magnesia, Jy 

Sugar, • gss 

Exi ract belladonna, gr. iij 

Hermes, gr.iss 

Orris, gr. iz. 

Mix the extract and the sugar, add the kermes and the orris, then 
the magnesia, and triturate to homogeneity. Divide into fiffy powders. 
Children of one year may take three per day between meals ; children 
from two to three years of age, five ; and older persons, eight. 



256 DISEASES OF CHILDREN. 

M. l > u . ) A I : i > I N BEAUMETZ, OE PARIS. 

This author, in his recently published (1882) Lecons de Clinique 
Therapeutique, recommends the bromides with chloral in the treatment 
of whooping-cough, lie; gives, morning and evening, in a glass of 
milk containing a yolk of one egg, a dessert or tablespoonful (accord- 
ing to the age of the child,) of the following mixture: 

278. &. Potass, bromid., gss 

Bodii bromid., ;; j 

A tnmonii bromid., g ss 

Byr. chloral., (Fr. cod.), gias 

Aqu», i.;--ij. M. 

DR. LUTON. 

According to the Medical Press, 1882, this author recommends the 
administration of sulphur, especially in the convulsive stage. Flowers 
of sulphur 8 to L5 grains, sugar of milk 10 grains. In ten powders, 
one every two hours, while carbonate of iron should be given to Keep 
up th<; strength, ten grains in the day. Coffee renders good service, 
and an emetic should be given every two days. 

MR. A. MCDONALD, OF SCOTLAND. 

This author (Edinburgh Medical Journal, L881,) says thai after 
an extended trial, he finds carbolic acid, in doses of one fourth minim 
to a child of six months, one-half minim for a year, and one minim for 

two years and upwards, to he the best remedy for whooping-COUgh. 

The whoop goes; the vomiting ceases, and the paroxysms are modified 
in intensity and frequency. l>r. J. Baugh, of Canada, (Canada 
Lancet, 1881,) adds his testimony to the efficacy of carbolic acid. For 
a child three years old he gives the following: 

27'.). U . Acidi carbolici, gr. iv 

Glycerini, ■ P. giss 

Byr. simp., . 1. g iv 

AqusB, ad I'.; ,1V. M. 

S. A teaspoonful every hour. 

DR. J. II. BSAGAN, ok TENNESSEE. 

The petroleum derivative cresolene is recommended by Dr, J. II. 
Eagan. The cresolene is vaporized, not atomized. The vaporizer 

Consists of a, metal cup, two inches in diameter and one inch deep, and 

a diaphragm, .supported by standards, six inches in height. An ordi- 



PERTUSSIS. 257 

nary toy kerosene lam}) will furnish the heat necessary for twelve 
hours. Aiomizing and spraying impregnate the atmosphere for a 
Limited time, as the particles, weighted with water, instantly gravitate 
to the ground. With q vaporizer, the vapor is diffused bo every pari 
of the room. Should the smell of the oresolene be offensive, a few 
drops of perfume will remedy bhe evil. J I is best to use the apparatus 
at night, closing the windows and doors, so that the vapor may be con- 
fined (Medical and Surgical Reporter, L880), 

I)!!, HENRI KENNEDY, OF [RELAND. 

According to this author ( Dublin Journal of The Medical Sci- 
ences, 1881), it is erroneous to claim that whooping-cough cannot be 
oured, and must be allowed bo pud its course. It is, he thinks, always 
a good rule, whether the child be feverish or not, to put it on a milk 
diet, al least for a time; In' has often seen relapses occur from the 
child getting solid meat when not in a fit slate Cor it. He gives medi- 
cines only during the evening and night; it is a good plan to give a 
dose after each paroxysm. The inhalation of chloroform, one or two 
whiffs direct from the hot tic will greatly mitigate the severity of the 
paroxysm. lie highly esteems the use *'\' bicarbonate of potassium, 
especially where there is fever; some anodyne may he added to it, es- 
pecially belladonna. Hemlock, he highly recommends, in doses of from 

two to four grains of the extract, to a child one year old, particularly 

after the fever has gone. Chloral, he oonsiders the remedy that yields 
the best and most constant, results; it comes as near a specific as any 
drug that ho knows of. When the bronchial seoretion is profuse, he 
reoommends emetics, given in the evening. When the disease lias be- 
oome chronic, he resorts t<> rubefacients, which arc useful in proportion 
to bhe redness they create, lie thinks he has seen the best results 
when they are rubbed over bhe stomach. 

DR. ED, .). BBAL. 

In the St* /<<>)< ix Clinical Record, L880, this physician claims 

gratifying results from the following: Three or four thicknesses of 
white flannel, four by lour inches arc quilted together and suspended 

by tape around the neck of the little sntlcrer, like a necklace. The pad 

so formed is to be saturated bhreeor four times daily with the following 

mixture, and to ho worn night and day. When the child sleeps, the 
pad must he placed in close proximity to the respiratory outlets. 
17 



258 DISEASES OF CHILDREN. 

280. R. 01. sassafras, f. 55 IIj 

01. terebinth., f. giv 

Ext. belladonna fl., zss 

Phenol, sodique, 5 iv. M. 

DR. DOLAN, OF ENGLAND. 

This author reviews all ^ 1C remedies usually recommended for 
whooping-cough, in the Midland Medical Miscellany , 1884. Bella- 
donna for general results, and salicylic acid, in the form of spray (J to 
i per cent.), for immediate relief, are credited with the best average 
of efficacy. Dr. Dolan deduces, with some force, from this conclusion 
(the salicylic acid having, in his belief, merely a germicidal action ) a 
support to the theory advanced in his previous essay of the fungoid 
origin of pertussis. The special form of microbe, rejoicing in the name 
of the bacillus pertussis, and believed to be pathognomonic of the dis- 
ease, has been described and shown by Professor BERGER. Dr. Dolan 
observes, however, that we must " recognize, as in phthisis, that the 
finding of the bacillus is only the first link ; experiments must deter- 
mine the connection between the organism and the disease." So ob- 
viously and readily contagious is pertussis, that such experiments, when 
performed, ought soon to furnish a definite conclusion. 



This judicious author remarks that we have no specific remedy (or 
whooping-cough, and of all those which have been recommended, 
hdladonna, in doses of the extract of \ or \ a grain three or four 
times a day, cither alone or in combination with quinine or the oxide 
of zinc, seems of greatest service. The dose of belladonna is to be 
gradually increased until symptoms of intoxication appear. When 
there is abundant mucous secretion and no vomiting, an occasional 
emetic is useful. 

Prof. Bartiiolow and others consider the best form for administer- 
ing belladonna is a solution of the sulphate of atropia : 

281. K. A.tropi» aulphatis, gr. j 

A.quae destillatee, f. § j. M. 

Two to four (hops at a dose;. 

He believes it most effective in the spasmodic stage, when there is 
profuse bronchial secretion. 



PBETUSSIS. 259 

MR. JOHN REYNOLDS, LONDON. 

282. K. Quiniee sulphatis, gr. xvj 

Acidi sulphurici diluti, q. s. 

Tinctures aurantii, I". 5,i 

Aquain, ad I'. 5 ij. M. 

Two teaspoonfuls every three hours. 

Mr. Reynolds claims for quinine a specific abortive power over 
whooping-cough. With the above formula he cures his cases in two 
days. Other physicians report, favorably of the method. To do good 
it must be pushed lo a quantity equal to a full antiperiodic dose. To a 
child under three years, ten grains should be given in twenty-four 
hours; to a child twelve years old, from sixteen to twenty grains 
should be given in the same time. 

Dr. V. Forcheimer, of Cincinnati, prefers to give quinine by insuf- 
flation. For this purpose a laryngeal insufflator is used — it matters not 
what kind ; this is introduced, and three or four of the powders, the 
formula for which follows, are blown daily into the larynx, but especi- 
ally upon the epiglottis and surrounding mucous membrane. 

288. U. QuinisB sulphatis, £j 

Sodii bicarbonat., 

Pulv. acacia-, flfl gr. XX. M. 

For ten powders. 

When this method is used as described, according to his exper- 
ience, no cases withstand it. 



DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

284. R. Alinninis, ►Hi** 

Syrupi zingiberis, 

Syrupi acacia', 

Aqua\ aa f. 5 j. M. 

A tablespoonful thrice daily, every live or six hours. 

This recipe, w hen prepared with good syrups, tastes very much like 
lemonade, rendering it acceptable to children. 

Our authors more generally employ alum in combination with bella- 
donna. They have obtained better results from the following formula 
than any other ever employed : 

285. K. Extract] belladonnas, gr. j 

Aliuniilis, g ss 

Syrupi zingiberis, 
Syrupi aoaoisB, 

A iiiia-, aa f.,\j. M. 



260 DISEASES OF CHILDREN. 

A teaspoonful morning, noon and night ; also once in the night, if the 
cough be troublesome. 

286. R • Potassii carbonatis, 9 J 

Cocci., £)ss 

Sacchavi albi, ^j 

Aquae, f. % iv. M. 

Dessertspoonful thrice daily, to a child a year old. 

This mixture has long enjoyed a high reputation in this country and 
abroad. Our authors, believing its efficacy to be due to the carbonate 
of potash, ordinarily omit the cochineal. This recipe, together with 
the alum and belladonna mixture given above, present the most useful 
agents we have to keep down the violence of the disease. 

DR. GOLDING BIRD, LONDON. 

287. R . Aluminis, gr. xxv 

Extracti conii, gr. xij 

Syrupi rhceados, f. 3 ij 

Aquse anethi, f-^UJ* M. 

A medium-seized spoonful every three hours in the second or nervous 
period of the disease, after the subsidence of inflammatory symptoms, 
and when the patient is harassed and exhausted by the attempts to get 
rid of the copious bronchial secretion. 

Under these circumstances, this author considers alum, which he ad- 
ministers according to the above formula, the most satisfactory of all 
remedies, affording the speediest and most marked relief. 

PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 

This author attaches considerable value to a well-managed treatment 
by sweating, especially at the commencement of the disease. When 
there is mucus in the throat, and a paroxysm of coughing is threatened, 
he gives: 

288. R . Coccinellse, gr. xij 

Potassii carbonatis, J} j 

Syrupi simplicis, f. % j 

Aquse, f. giij. M. 

A teaspoonful at a dose. 

Dr. Niemeyer cannot admit that any narcotic whatever (belladonna 
included) has any specific action against this disease. Should the treat- 
ment given above prove ineffective, should the child empty its stomach 
with every paroxysm, should his nutritive condition begin to suffer 
from constant vomiting and sleepless nights, should convulsions or signs 
of actual suffocation occur during the seizures, the administration of nar- 



PERTUSSIS. 261 

cotics is indicated. Belladonna enjoys this advantage over opium that, 
in the condition of the pupil, we have an index for regulation of the 
dose. To children between the ages of two and four years, we may 
give the J- of a grain of the drug, night and morning, gradually increas- 
ing the dose up to f a grain, or until the pupil begins to dilate. For 
older children small doses of morphia (gr. tV-J, in die). If, imme- 
diately after the cough, there still remain audible rales in the chest, if 
the child grow short of breath, or the respiration become enfeebled 
throughout a part of the thorax, an emetic should be given forthwith, 
and repeated whenever the symptoms recur. In the third stage, when 
impoverishment of the blood and general exhaustion furnish the most 
urgent symptoms, the free administration of meat diets, eggs, wine, and 
the ferruginous preparations, is indicated. 

NOTES ON REMEDIES. 

*Acidum Carbolicumis highly recommended (see p. 256). 

Acidum Hydro cyanicum, useful after the catarrhal symptoms have diminished. 
Dr. West was accustomed to prescribe a dose of £ a minim of dilute 
hydrocyanic acid every six hours for a child nine months old, gradually 
increasing the dose to 1 minim every four hours for a child of that age, 
and so in proportion for older children. It is also recommended for the 
cough kept up by habit after the subsidence of the disease, and the 
cough by imitation. 

Acidum Nitricum sometimes benefits exceedingly, but it is uncertain. It should 
be given well diluted in sweetened water. 

Alumen. Dr. Ringer is of opinion that in complicated cases few remedies give 
better results than alum ; he gives gr. ij-vj every three hours. 

Ammonii Picras. Dr. Z. T. Dellenbatjgh {Medical Times, September, 1878,) 
reports a number of cures with this agent in from twenty-four to sev- 
enty-two hours, and claims it as a specific. The dose to babies is gr. 
y'a ; to children, gr. £, every three hours. 

289. R . Ammon. picratis, gr. ij-iij 

Amnion, muriat., 

Ex. glycyrrhyz., aa gj 

Aquae ad., fl. giij. 

S. — Fl. ^ j. every three hours. 

Amyl Nitrite. This is one of the late cures for whooping-cough. Dr. Sawa- 
rosky directs the patient to breathe several times a day a mixture of a 
few drops of nitrite of amyl in a drachm of chloroform ; at the same 
time administers, internally, for three days, every two hours, T *j of a 
grain of silver cyanate and three grains of pure clay. Hot food and 
drinks must be avoided. A cure is effected in a few days. Dr. George 
Bayles has also reported on its use very favorably. (Va, Medical 
Monthly, August, 1877). 



262 DISEASES OF CHILDREN. 

Argenti Iodidum, gr. ^, to a child three years old, is recommended by Dr. Bart- 

lett as a most effective and pleasant remedy. 
Argenti Nitras. Drs. McNutt and Maxwell {Boston Medical and Surgical 

Journal, August 16th, 1871,) use a solution of nitrate of silver, gr. xv 

to the ounce, applied by the spray atomizer, which seldom fails to effect 

a cure. 
Argenti Oxidum. Dr. W. Macfarlane {Australian Medical Gazette, December 

15th, 1869,) has every reason to believe that oxide of silver shortens the 

pertussis ; dose, £ of a grain, three or four times daily, in any simple 

powder, up to one year of age. 
Assafcetida is a disagreeable but useful remedy, and may be given freely to 

infants and young children. 

Belladonna. Prof. J. Lewis Smith, of New York, commonly employs the 
extract of belladonna in 1-grain pills. For an infant one year old, one 
pill is dissolved in eight teaspoonfuls of water; three years, in four 
teaspoonfuls. A teaspoonful to be given one, or, if there be no 
appreciable effect, three or four times daily. If there be no modifica- 
tion of symptoms, an additional half spoonful should be given on the 
third day. If atropia is used, gr. t |q, twice daily, is sufficient. 

Benzine, in doses of gtt. xx-xxx in sweetened mucilage, is praised, by Drs. 
Bottare and Lochner. It has also been inhaled. 

Bryonia. In a communication to the Journal de Therapeutique, May 25th, 1878, 
Dr. Louvet-Lamar stated that he had derived great advantage from 
treating the catarrhal stage of pertussis by the tincture of bryony, and 
the paroxysmal stage by the tincture of drosera. Of the former, he 
gives one gramme per diem to a child seven years old, and although it 
may not abridge this first stage of the disease, it diminishes the 
tracheo-bronchitis very sensibly, and therefore the violence of the 
cough. When the bronchial tubes are overloaded with mucosities, he 
also administers an emetic. As soon as the paroxysmal character be- 
comes well established, he gives the tincture of drosera, (one gramme 
daily for a child seven years old,) and as long as there are any rales 
heard in the chest he associates the bryony with it. It soon lessens the 
violence of the paroxysms, but may have to be continued two or three 
weeks before convalescence is established. These agents were intro- 
duced by American ''eclectic" physicians. 

Calx. The carbolate of lime is recommended by Dr. Ed. M. Snow. The gas 
from the lime used in gas-works has been shown by Dr. W. S. King to 
be a remarkable alleviant in whooping-cough, {Med. and Surg. Re- 
porter, May, 1867). 

Camphorm Monobromas is a useful sedative. 

Castanea, chestnut leaves, recommended by Dr. Ludlow, of Cincinnati : 

290. R . Castaneae vescse, ,^ss 

Aquse bullientis, Oj. M. 

Add to this a pint of cold water ; sweeten with white sugar, to make 



PERTUSSIS. 263 

it palatable, and administer cold. As much should be given dur- 
ing the day and evening as the patient can be induced to take. 

Dr. J. Coopreider, of Taylorsville, Ind., writes to the Canada Med. 
Record, (1883,) that he has used the fluid extract of chestnut leaves for 
whooping cough, with great success. 

The dose employed is from fifteen to sixty drops, according to age. 
If the child is large enough, he gives it in hot water as an infusion, 
sweetened ; to a small child, in simple syrup or elixir. 

It not only relieves or lightens the paroxysms, but will actually cure 
in from four to five days. 

He gives four to six doses per day, according to the severity of the 
case. 

If good fresh leaves can be procured, he makes the infusion as a tea, 
say two drachms of the leaves to half a pint of boiling water, and gives 
two ounces at a dose, sweetened with white sugar. 

Cerii Oxalas. This salt is given in doses of gr. ss-ij, before breakfast, on § 
daily. Dr. T. Clark has recommended it in the Practitioner, 1879 ; 
and a New York physician, Dr. Morje, has reported favorably from 
its use. 

Chloral, in small doses, allays the cough. Dr. P. B. Porter, of New York, 
after extensive trials, says he has found it, on the whole, the most re- 
liable and satisfactory agent that he has employed. It has the great 
advantage over quinine in solution (which he has also used with suc- 
cess), of not being unpleasant to the taste when given in syrup. 

Croton Chloral has been highly praised by recent writers. A child a year old 
can take 1 grain every four hours. It should be specially impressed on 
parents and nurses, that to do good it should at first be given every 
four hours, night and day, even should the patient require waking up. 
At the end of week, it need only be every four hours during the day, 
and at night when the patient is awake. 

The worst cases usually completely yield in a fortnight. The drug 
does not upset the digestive organs, and, by lessening the frequency 
and duration of the paroxysms, puts an end to troublesome epistaxis 
and vomiting. Sometimes the first few doses produce a feeling of irri- 
tation about the throat and fauces, but this soon passes off. It may be 
given, gr. j-ij dissolved in compound tincture of cardamom, and sweet- 
ened with glycerine. (See Drs. Webb and Moore, page 253.) Dr. 
Farquhar, of Zanesville, Ohio, confirms all that Dr. Webb says about 
croton chloral and speaks highly of the following : 

291. R. Croton chloral, gr. xv 

Ether sulph., gtts. xx 

Potass, bromid., 3.1 

Tr. belladonnas, gtts. xv 

Tr. hyoscyami, gtt. xxiv 

Syr. tolu., adf.^iv. M. 

S.— One teaspoonful every four hours until better, then only three 
times a day. 



264 DISEASES OF CHILDREN. 

Drosera. See Bryonia. 

Ferri Carbonas administered in cakes (one grain for each year up to six years 
old, every three or four hours), is highly praised by Dr. W. H. O. 
Sankey, in the Birmingham Medical Review, 1884. 

Hydrargyri Sulphur etum Nigrum, in doses of gr. vij daily, is strongly recom- 
mended by Dr. Chiricozzi. (Dobell's Reports, 1877.) 

Hydrobromate of Cicutin. This salt of the alkaloid of hemlock has been em- 
ployed in whooping-cough, asthma, and pthisical cough, by M. Lan- 
due, with satisfactory results ; fa to -fa may be given an adult every 
hour or two. (Bull. Gen. de Therapeutique, May, 1876.) In pertussis, 
it is given in doses of fa of a grain, if necessary, every hour, for a 
child three years of age, or fa of a grain for a child of one year, and % 
of a grain for adults. 

Lactucarium. The syrup of lactucarium is a useful vehicle for the exhibition 
of other medicines. 

Lobelia has been used successfully, especially after the cessation of the catarrhal 
stage. It is adapted to cases in which the cough is dry, resonant and 
spasmodic. It succeeds best in those who have attacks of cough with 
spasmodic difficulty of breathing, and who get up a litte tough mucus 
after long and painful paroxysms of coughing. (Bartholow.) 

Morphia, especially the bimeconate, in small doses, is an excellent sedative for 
the cough. 

Morrhum Oleum. Mr. Prestwich (Lancet, December 9th, 1871,) reports a few 
.cases, selected from more than thirty in his own practice, in order to 
show the value of cod-liver oil in this complaint, which he looks upon 
as a specific. 

Petroleum. Dr. Lesser rocommends rubbing the chest twice a day with a tea- 
spoonful of this substance. 

Potassii Bromidnm and Ammonii Bromidum are popular and efficient sedatives. 
They may be combined with belladonna, or syrup of wild cherry : 

292. R . Potassii bromidi, gr. j-v 

Extracti belladonnae, gr. £-j 

Syrupi papaveros, i^xv 

Aquae, f. 5ij. M. 

For one dose every two or three hours. (Dr. E. Ellis.) 

Potassium Chloridum. Jacques Munk, in Pester Med. Chir. Presse, 1880, reports 
favorably on the use of chloride of potassium in from one-half to two- 
grain doses, given with one-sixth of a drop of laudanum, every two 
hours. 

Potassii Nitras. The inhalations of nitrous fumes has been recommended. 

Potassii Sulphuretum, commended by Dr. MacKelkan, of Canada, in doses of 
gr. iij-vj in sweetened water. Its beneficial effects are not perceived for 
five days, when the intervals between the paroxysms of cough become 
longer, and, after that, their violence diminishes from day to day, until, 



PERTUSSIS. 265 

at the end of ten or fourteen days, it is seldom necessary to pursue the 
treatment further. As the drug easily spoils by keeping, it is import- 
ant to have it fresh. 
QuinicB Sulphas is regarded as an almost certain abortant by many. (See 
above.) Dr. C. F. Swan, of Chicago, {Med. Jour, and Examiner, 1877,) 
recommends Prof. C. Binz's formula : 

293. R. Quiniae sulphatis, 5J 

Acidi tannici, gr. xv. M. 

This aborts one-third to one-half the cases, in three or four days. Dr. 
Lasinsky treats his patients by insufflations of a powder composed of 15 
grains of hydrochlorate of quinine, 30 grains of salicylic acid, and 7 
grains of bicarbonate of soda and white sugar. A small quantity of 
this powder is blown into the larynx twice a day. He states that, in 
the course of eight days, the attacks become greatly reduced in violence 
and frequency. (Dobell's Reports, 1877.) It is also recommended by 
Dr. W. Thornton Parker, U. S. A., who gives every two hours a tea- 
spoonful of a solution of sulphate of quinine, four, six, eight or even ten 
grains to the ounce {Medical and Surgical Reporter, 1883.) 

The following is recommended by a British authority as almost a 
specific in this disease. 

294. R . Quinise sulphatis, ►} j 

Sol. acid, hydrobromic, (Fothergill), 5.j ss 

Syrupi al these, f. .^jss 

Aquae, adf.^yj. M. 

S. — A dessertspoonful four times a day. The dose to be increased ac- 
cording to age. 

Sodii Benzoas. Tordens has used it successfully in Wliooping Cough, using the 
prescription of Letzerich. 

295. R. Sodii benzoat., ^iv 

Aq. destil., 

Aq. menth. pip., aa 3 X 

Syr. aurantii, £ij. M. 

S. — Two drachms every hour or two. (Bartholow.) 

But, on the contrary, Dr. J. Shelton Hill, of Maryland, has found 
that it has no influence on the frequency of the paroxysms and but little 
on their intensity, though it did check the vomiting {Medical and Surgi- 
cal Reporter, 1880). 
Terebinthinm Oleum, in pertussis complicated with irritative fever, bronchitis, or 
convulsions, is praised by Dr. Bedford Brown, of Alexandria, Va. 
It is also highly recommended by M. Barety, of Nice, {V Union 
Medicale, 1881). He places deep plates containing this liquid under the 
head of the bed and in the comer of the room. The paroxysms of 
coughing soon become less marked, and the malady, taking on a benign 
character, generally lasts about one month. 






266 DISEASES OF CHILrKEN. 

Tonka Bean has been employed with success by Dr. John Cooper, of Philadel- 
phia ; gtt. v-viij of the fluid extract every three hours, to a child five 
years old. 

INHALATIONS. 

The inhalation of very numerous substances has been tried in whoop- 
• ing-cough. Referring for the complete list to the works of Dr. J. 
Solis Cohen and others, we mention as most promising of success : 
Alumen. £j to water ^yj, to be used twice daily, ten minutes, at a time. 

(SlEGLE.) 

Ammonia Liquor, f. 5§j to a gallon of boiling water. Place in an open pan by 
the bed-side, and evolve steam by introducing a red-hot brick. 

Amyl Nitrite, gtt. ij-iij, on a handkerchief, when a paroxysm is impending. 

Argenti Nitras, gr. ss-j to water f. ^ j. Inhale by a nebulizer f.^ss twice daily. 
Protect the face with a mask, or by smearing with salt and butter. 

Belladonna. Make an infusion and inhale the vapor ; or, better, throw about 
3ij of the leaves on burning coals, and let the patient inhale the smoke. 

(SCHROEDER.) 

Benzine. Place small quantities in a number of shallow vessels about the room. 
Benzole. A writer in the Lancet, 1881, recommends benzole vapor as prepared 
by an atomizer. 

Brominium. Dr. Vogelsang, of Switzerland, finds that one or two scruples of 
bromine, and as much bromide of potassium, to a tumblerful of hot 
water, placed in the room of a child suffering from whooping-cough, 
affords it great relief. The mixture should be renewed three or four 
times a day. Dr. J. J. Caldwell recommends : 

296. B . Potassii bromidi, gj 

Ammonii bromidi, 9 ] j 

Extracti belladonnas fluidi, gtt. x 

Aquae destill., f.gij. M. 

A tablespoonful once or twice daily with a nebulizer. 

Dr. Wimtreben (La France Medicale, 1880,) habitually uses a solu- 
tion of bromide of potassium, one in twenty, and repeats the applica- 
tion of the spray for one minute after each fit of coughing, when the 
mucous membrane of the breath passages, free from the mucus which 
usually covers it, is accessible to the action of the remedy. 

Calcis Carbolas. Dr. E. M. Snow, of Providence, R. I., has often recom- 
mended carbolate of lime as a remedy to relieve the spasmodic fits of 
coughing in this disease, and the evidence is abundant that it is of real 
value for this purpose. It is used by exposing it to the air in the rooms 
where the children live and sleep, so that the odor will be plainly per- 
ceptible at all times. 

Carbolicum Acidum, in a solution of one and a half to two per cent., boiled in a 
Siegle apparatus and inhaled three times a day into the widely-opened 
mouth. The violent paroxysms of cough disappear in two or three 
days. (Burchard.) 



PLEURITIS. 267 

Carbonicum Acidum, by inhalation, is highly recommended by several authori- 
ties in the Rev. de Titer apeutique, 1883. It is obtained from an appa- 
ratus for making seltzer water, and is slowly inhaled through a long 
rubber tube placed at the nasal orifice. 

Chloroform may be inhaled to check the coughing. 

Cresolene is recommended by Dr. J. H. Eagan. (See page 256.) 

Etlter is valuable for the same purpose. 

Ferri Tinctura Chloridi, gtt. iij-x to water f. 5 j, in the nebulizer, sometimes 
succeeds remarkably. 

Quinice Tannatas. Dr. Pollak, of Austria, recommends the following : 

297. R . Quinise tannatis, 

Sodii bicarbonatis, aa 5 parts 

Pulv. acacias, 100 parts. M. 

S. — Use with an insufflator. 

Sodii Carbolas, is called by Dr. Pernot, of Lyons, a specific in the disease. 
He places the carbolateof soda in a small porcelain crucible held above 
the flame of a spirit-lamp, which keeps it at an unvarying temperature 
as long as wished ; the carbolate of soda becomes volatilized, so that 
scarcely any of it remains in the crucible, but the atmosphere of the 
sick room is impregnated with the vapor of carbolic acid mixed with 
the elements of coal-tar. The little apparatus above described is not 
always at hand, but a fire-brick is generally to be had, either in town 
or country, and this, heated to a sufficiently high temperature to 
vaporize the carbolate of soda, is generally employed by Dr. Pernot. 

Sulphurosum Acidum, evolved by sprinkling some flour of sulphur on red-hot 
coals, has been extensively employed in Europe in whooping-cough. 

Terebintltinm Oleum, in vapor, has been repeatedly praised in this disease. Pro- 
fessor Skoda directs that some be poured on boiling water and the 
patient inhale the vapor for fifteen minutes at a time. Dr. A. Gerth, 
of Switzerland, prefers that twenty drops be placed on a handkerchief, 
held to the mouth and nose, and inhaled in thirty or forty deep inspira- 
tions. This is repeated thrice daily. 



PLEURITIS 



DR. LOUIS STARR, OF PHILADELPHIA. 

According to this author (Archives of Pediatrics, 1884,) the child 
must be kept at perfect rest in bed. Over the affected side he applies 
a poultice to act as a counter-irritant, drawing the blood to the surface 
and relieving the congestion of the pleura. As there is an inflammatory 



268 DISEASES OP CHILDREN. 

fever, a light and nutritious diet must be selected, since fevers of this 
kind are accompanied by gastric catarrh, and strong food cannot be di- 
gested. The only medicines indicated are diaphoretics, as: 

298. * R . Spts. sstheris nitrosi, f. 5ij 

Liq. potassii citratis, q. s. ad f.giij. M. 

S. — A dessertspoonful every two hours. 

Sometimes, after fever has subsided, you will hear a friction soun^i 
on auscultation, especially when the breathing is forced, as it is after 
running or coughing, showing that plastic exudation has taken place, 
and that there may, perhaps, be a tendency to adhesion between the 
two pleural surfaces. Under these circumstances, an alterative is 
called for, to favor the absorption of the effused lymph. For this pur- 
pose iodide of potassium is most useful ; beginning with doses of one or 
two grains in half a fluid drachm each of compound syrup of sarsaparilla 
and water, three times a day ; or, if there be anaemia, ten drops of the 
syrup of the iodide of iron three times a day may be substituted. 
Locally, an ointment consisting of equal parts of the compound iodine 
ointment and lard may be applied twice a day. If the tincture of 
iodine is used, inflammation of the skin is likely to be produced, and 
after this has occurred no more of the iodine is absorbed. The oint- 
ment, when properly diluted, causes no such result. The iodine is ab- 
sorbed, and thus we get an alterative effect, in addition to a counter- 
irritant action. 

DR. ARMAND SEMPLE, OF LONDON. 

In acute pleuritis the child may be enveloped in a large jacket poul- 
tice. With a strong, healthy child a few leeches may be placed on the 
side, and a saline diaphoretic administered, such as acetate of ammonia 
or nitrate of potash combined with a little antimonial wine ; a grain of 
calomel combined with the compound ipecacuanha powder is useful. 
The regimen should be antiphlogistic. In chronic pleuritis the diet 
must be liberal ; good food and wine should be given. Blisters may 
be applied from time to time. The chest may be painted with iodine. 
Iodide of potassium, bark, squills, digitalis, and acetate of potash may 
be given internally. In anaemic children, tonics, such as quinine, 
strychnia, the various preparations of iron and cod liver oil, may be 
given. When the process of absorption fails, the lung becoming ser- 
iously compressed, giving rise to urgent dyspnoea, the pulse being 



PLEURITTS. 269 

irregular, the heart feeble or the fluid becoming foetid, and great con- 
stitutional disturbance occasioned, the patient being in danger from 
hectic fever and septicaemia, the operation of paracentesis thoracis is 
demanded, and care should be taken that this operation is not delayed 
too long. The following are the cases calling for paracentesis: 

1. Those cases in which the fluid is so abundant as to fill one pleura 
and induce compression of the lung of the opposite side. 

2. Cases of double pleuritis, in which the whole amount of fluid may 
possibly occupy a space equal to the capacity of the two pleural cavities. 

3. Cases in which the amount of effusion has given rise to one or two 
attacks of orthopnoea. 

4. Cases in which a large effusion has existed for a long time (a 
month or so), and in w T hich there has been no indication of progressive 
absorption. 

5. In every case in which the contained fluid is suspected to be 
purulent, an exploratory puncture should be made and the fluid evac- 
uated. 

DR. EDWARD HENOCH, OF BERLIN. 

At the onset, when severe pain is present, he considers the applica- 
tion of a number (corresponding to the age) of wet cups (dry cups in 
feeble children) as necessary. Hydropathic applications should also 
be made constantly, while infusion of digitalis, combined with nitrate of 
potash, is given internally. 

299. & . Inf. digitalis, f. I iij 

Potass, nit., gr. xxx-xlv 

Syrup, f. 5 v. M. 

S. — Teaspoonful every two hours. 

Calomel and digitalis also do good service, especially when constipa- 
tion is present. 

300. R . Calomel, gr. \ 

Pulv. digital., gr. \ 

Sacch. alb., gr. j. M. 

S. — Give this powder every two hours. 

With the increase of exudation, diuretic treatment comes to the fore- 
ground, viz.: infusion of digitalis and acetate of potash, In sub-acute 
cases he recommends infusion of bark, with acetate of potash, cod-liver 
oil, whey and country or mountain air. 



270 DISEASES OF CHILDREN, 

S. HENRY DESSAU, M. D., NEW YORK CITY. 

It is observed by this writer (Medical Record, September, 1878,) 
that pleurisy is frequently overlooked when it occurs in infants. For 
its detection as well as an aid to treatment, he recommends that when- 
ever a doubt exists in the mind of the physician in regard to the diag- 
nosis of even the simplest case of pleurisy, it should at once be cleared 
up by an exploratory puncture of the chest-wall with an ordinary hy- 
podermic syringe, as recommended by Eustace Smith, and later by 
Dr. Thomas Barlow and Mr. R. W. Parker, of London. The oper- 
ation is perfectly harmless, does not give much pain, and may be re- 
peated several times if necessary. The puncture is best made in the 
intercostal space, immediately below and on a line with the angle of the 
scapula. When the effusion is localized or circumscribed, as is some- 
times the case, the puncture is advised, by the last-mentioned writers, 
to be made over the centre of maximum dullness. 

Dr. Dessau has frequently found the withdrawal of a syringeful of 
fluid, obtained on exploratory puncture, to rapidly hasten the absorption 
of the effused fluid. This has been explained as due to the relief of 
pressure stimulating the absorbents of the pleura. 

For internal treatment he prefers small doses of infusion of digitalis 
together with syrup of the iodide of iron. Moderate counter-irritation 
over the back is occasionally useful, and as a tonic to hasten convales- 
cence, sulphate of cinchonidia. 

EDWARD ELLIS, M. D., LONDON. 

This writer is satisfied of the relief which calomel and opium often 
give in the acute pleurisy of childhood, and sees no objection to their 
employment. The best form is : 

301. R. Hydrargyri chloridi mitis, gr. ss-j 

Pulveris ipecac, et opii, gr. j-iij. M. 

He can speak well of both aconite and veratrum viride in the earliest 
stages, but both of these, especially the latter, must be discontinued as 
soon as a decline in the pyrexia is established. 

For the relief of the pain we may prevent the movement of the side 
by fixing it in place by strips of adhesive plaster several inches wide, 
and long enough to reach from the middle of the spine to the middle of 
the sternum. They should be applied at the close of an expiration, 



PLEURITIS. 271 

while the lung is emptied of its air. Another means is a lotion of 
aconite or opium applied immediately over the painful spot, and covered 
with a poultice. 

Later in the disease, when the pyrexia has disappeared, a combina- 
tion of iodide and citrate of potash with digitalis will be found very 
useful, e. g.: 

302. R. Potassii iodidi, gr. viij 

Potassii nitratis vel citratis, gr. xxxij 

Infusi digitalis, f.gj 

Syrupi, f.3ij 

Aquam, ad f. ^iv. M. 

A tablespoonful for child six years old. 

Care should be taken that the infusion of digitalis be freshly made. 

For the treatment of the effusion, painting the side with iodine 
tincture, or a succession of flying blisters, or finally, paracentesis 
thoracis, are our resources. The last-mentioned operation is growing 
more into favor, the more extensively it is adopted. It should not be 
postponed until the patient is in extremis and the powers of nature are 
exhausted. 

DR. THOMAS BARLOW AND MR. R. W. PARKER. 

In regard to the treatment of pleuritic effusions in children, these 
writers {British Medical Journal , August 25, 1877,) strongly recom- 
mend an exploratory puncture, and the removal of a small quantity of 
serum. When the history is recent, and the effusion serous and small, 
they abstain from further operative interference. When three weeks 
elapse without improvement, they recommend the additional removal of 
a small quantity, either by the hypodermic syringe or the aspirator. 
If the effusion be considerable, it is right to perform paracentesis at 
once ; not only to relieve dyspnoea, but to give the lung a chance of 
•re-expansion before adhesions bind it down. Paracentesis should be 
performed quite irrespectively of pyrexia. 

As to drugs, they have seen no benefit whatever from their use in 
pleuritic effusion. No harm results from the external application of 
iodine ; indeed, it has seemed that its use, combined with the internal 
administration of iodide of potassium, has produced benefit. In this, 
as in every other wasting disease of childhood, cod-liver oil is invalu- 
able. 

If the exploratory puncture reveals the presence of pus, it is recom- 
mended to withdraw as much as possible with the hypodermic syringe. 



272 DISEASES OF CHILDREN. 

It is quite marvelous to observe the rapid improvement which fre- 
quently follows the emptying of a very small collection of pus. If 
the quantity of pus removed be incommensurate with the extent and 
intensity of the dullness, subsequent punctures must be made. If the 
pus does not become foetid, and if at each successive operation the quan- 
tity notably diminish, there seems no reason to limit the number of 
attempts to cure the empyema by repeated aspiration. If the pus 
should become foetid, or rapidly re-accumulate in larger quantity, per- 
manent drainage is recommended. In all cases, it is contended that 
this should be by a double opening. If possible, the first opening 
should be made in the front of the thorax, and the second below and 
internal to the angle of the scapula. A long probe, threaded with a 
piece of drainage-tube, may be passed downward and backward from 
the first opening, and the second incision made ever the point of the 
probe when it is felt through the integuments. The drainage-tube 
should then be drawn through and secured by tying the* two ends 
together. 

Most of the cases with which they have been concerned have been 
dressed with oakum. They have seldom had need to use stimulant 
injections ; but in one case they saw marked and rapid improvement 
from the use of a solution of quinine, 5 grains to the ounce. One of 
the strongest arguments in favor of the method of double openings is 
that in a large proportion of cases, it dispenses with the need of wash- 
ing out the empyema cavity. It is well known that washing out the 
chest has been followed, in a certain number of cases, by sudden death. 

NOTES ON REMEDIES. 

Sodium Cldoriclum. Common salt has been found very useful in pleuritic effu- 
sions by Dr. Tom Robinson (British Medical Journal, 1883). He gives 
to an adult one drachm in a wineglass of water twice a day. The dose 
should be proportionately decreased for children. 



PNEUMONIA. 



DR. EDWARD HENOCH, OE BERLIN. 

According to this author, the expectant treatment, usually recom- 
mended in the pneumonia of adults, will also hold good during the 



PNEUMONIA. 273 

period of childhood. He only uses wet cups when there is intense 
dyspnoea and great extension of the pneumonia, and in a complication 
with severe pleurisy when required on account of violent pains in 
breathing and coughing. When the pneumonia is restricted in extent 
and the pleuritic complication is absent, or at least does not occupy the 
foreground, bleeding should not be employed, and it is best to resort 
to cold applications or fomentations to the chest (see bronchitis) which, 
so long as the high temperature continues, are renewed every half 
hour, later every hour or two. The application of an ice-bag to the 
head or abdomen is also advisable. He has ceased the use of quinine 
and other antipyretics, and confines himself to the local application of 
cold. Internally he gives digitalis and nitrate of potash. 

303. R . Inf. digitalis, f. g iij 

Potass, nitrat., gr. xxx-xlv 

Syrup, f. 3v. M. 

S. — Teaspoonful every two hours. 

This, however, is contra-indicated by any gastric complication (re- 
peated bilious vomiting, thickly-coated tongue, nausea). In this event 
he orders : 

304. &. Acid, hydroclilor., gtt. j-xv 

Aq. destil., f. ^iij 

Gum. arab., gr. xv 

Syr., f.3v. M. 

S. — Teaspoonful every two hours. 

In very rare cases he has given tartar emetic, when bilious, gastric 
symptoms (constant frontal headache, vomiting, foetor of the breath) 
were prominent, and it was always very successful in such cases. 

DR. ARMAND SEMPLE, OF LONDON. 

This author recognizes two types of pneumonia which demand very 
different handling — the one sthenic or plethoric, the other asthenic. 
The former is, at the present day, comparatively very rare, the large 
majority of cases being of the latter kind. The sthenic form may re- 
quire blistering and leeches, with depletory remedies, such as mercurials 
and antimonial preparations. The asthenic form will derive benefit by 
the application of jacket poultices of linseed-meal, i. e., encircling both 
the back and chest of the patient ; the linseed-meal should have the oil 
crushed in it, and a little oil should be smeared over the surface of the 
18 



274 DISEASES OF CHILDREN. 

poultice. These poultices should be tolerably thick, moist, thoroughly 
warmed and frequently changed. Decoction of poppies may be used in 
place of water for forming the poultices, if severe pain is present. In- 
ternally aconite preparations, ipecacuanha, citrate of potash, acetate of 
ammonia, spiritus astheris nitrosi and senega, may be administered. The 
strength should be supported by strong beef tea, eggs and milk, and if 
the exhaustion be very great, carbonate of ammonia, brandy or port 
wine may be given. If the sputa be viscid, and urine cloudy, alkalies 
are indicated. For want of sleep, hydrate of chloral may be used, and 
it is advisable to combine this drug with belladonna, by which the en- 
feeblement of the vaso-motor system, and the diminished activity of the 
respiratory centres, caused by the chloral hydrate, are obviated. The 
above-named drugs, especially aconite and hydrate of chloral, must be 
very cautiously administered. Bromide of potossium is a safer remedy 
than chloral, since it exerts a sedative action on the nervous system by 
depressing the action of the heart. During convalescence, cod-liver 
oil and iron preparations are the appropriate remedies. 



This author describes in the Beidscli. Arch. fur. Klin. 3fed., 
1883, a form of sejjtic pneumonia in children, which, from his remarks, 
it would seem is always fatal. He thus describes it: 

1. The septic pneumonia of infants and nursing children, and which 
begins as a tracheo-bronchitis, is a catarrhal, and very often a foreign- 
body pneumonia. 

2. It begins by the aspiration of decomposing amniotic fluid and 
genital secretions, or by the inspiration of strongly-infected air from 
some septic disease of the mother. 

3. Septic pneumonia of infants frequently accompanies diseases of 
the pleura, but seldom of other organs. 

4. The alveoli and bronchi of the lungs of children dead of septic 
pneumonia are filled with bacteria. 

5. The blood shows an increased amount of white globules, and a 
broken-down condition of the red. 

6. Icterus is not a constant accompaniment of the disease. 

7. The time at which the disease occurs is from one to two days after 
birth, and death usually takes place in about two days. 



PNEUMONIA. 275 

DR. JOHN M. KEATING, OF PHILADELPHIA. 

In the first stage of croupous pneumonia this author uses (Medical 
and Surgical Reporter, 1882,) large, thinly-spread mush or flaxseed 
meal poultices as hot as the child can bear them (to be tested by the 
hand) changed every three hours and covered with oiled silk, which he 
prefers to hot baths, though hot foot baths, with a tablespoonful of mus- 
tard can be used twice or thrice daily. He also gives the bisulphate 
of quinia, gr. iij, twice daily, by suppository, to keep clown high tem- 
perature, with instructions to use one of gr. v should the temperature 
register 105°. He also uses whisky or brandy in 5j closes, to aid the 
suppository in reducing temperature, if required ; the desire being to 
keep the temperature below 105°. He insists strongly on the import- 
ance of making out for the mother or attendant a register of diet and 
medicine, to be strictly adhered to, so that you can readily see what 
your patient is getting. If the patient is fretful or sleepless, you can 
give two grains of Dover's powders, using the bromide, instead of the 
sulphate of potassium, at night. When mucous rales are heard over 
entire consolidated lung, you can replace the poultices, by a thick layer 
of cotton wadding, changing it twice daily, and rubbing the surface of 
the chest with the following liniment : 

305. R. 01. succini, f.zij 

Liniment saponis, f. ^ vj. M. 

You may use cod-liver oil, in place of sweet oil in the liniment. In 
a few days he uses an external application of the following : 

306. R. Tinct iodinii, f.gj 

01. myrrhae ; ol. olivae, aa gvj . M. 

Sig. — Well rubbed in. 

If you wish now to give tonic doses of quinia and iron in some form. 
You can order : 

307. R. Quiniae et ferri citratis, gr.xij 

Syr. limonis, f. ^ ss 

Aquae, q. s. ad f. 3 iii. M. 

S. — Dessertspoonful tliree times daily. 

Or: 



M. 



08. R. Ferri amnion, citrat., 


gr.xij 


Syr. amyg. amar., 


f. % ss 


Aquae, 


q. s. adf.giij. 


i. — Dose gij-iv. 





276 DISEASES OF CHILDREN. 

And give the quinia still by suppository. If the cough is loose, but 
annoying, he gives : 

309. R. Ammon. muriat., gr.viij 

Syr. scillse, finely 

Tinct. opii camph., tt^xxiv 

Syr.tolut, q. s. adf. ^ij. M. 

S. — Teaspoonful three times a day. 

And if the secretion is free and you think it advisable to act gently 
on the intestine to carry off the accumulated mucus, you can use : 

310. R . Lig. potass, citratis, f. ^j 

Syr. pruni virg., f-5 ss 

Glycerin®, f/Jij. M. 

S. — Dose 3h-iv. 

In the third stage, the greatest danger is from weakness. Here the 
child needs supportive treatment — iron in particular, quinine , milk- 
punch or wine-whey, cod-liver oil, with the phosphates and the hypo- 
phosphites. He orders, especially if the children are run down: 

311. R. Syr. ferri. iodidi, f. z j 

Emul. ol, morrliuse (fifty per cent.), f. ^fiij M. 

S. — Dessertspoonful t. d. 

M. JULES SIMON, OF PARIS. 

According to the Medical Press and Circular, 1882, M. Simon 
recommends dry cupping at the beginning and poultices. The next 
day or the following, small blisters, left on for three or four hours, and 
when taken off, another poultice applied and left on for an hour, when 
the blisters will have arisen and can be dressed. This revulsive treat- 
ment should be continued throughout the whole course of the disease. 
Internally, he gives : 

312. R . Tinct. scillae, 

Tinct. digitalis, aa gtt. x 
Syrupi, f.gj 

Aquae acacias, f-^hj- M. 

S. — A teaspoonful every two hours. 

The digitalis and the squills should be suppressed after four or five 
days. Milk should be freely given, as it acts as a good diuretic. 



Usually the best treatment in the lobular pneumonia of children is to 



PNEUMONIA. 2 i < 

keep the patient in bed in a room of about 60°, well ventilated, with- 
out a draught, milk diet during the height of the fever, and when the 
temperature falls, some good beef tea, and a simple saline mixture, such 
as : 

313. R . Potassii citratis, J} j 

Syrupi aurantii, f-.^ij 

Aquam, q. s. adf. ^ij. M. 

Two teaspoonfuls as required. 

The tendency of the disease in children is to recovery. The great 
point is to do nothing which will interfere with rapid convalescence. 
Antimony is seldom desirable or necessary ; if given at all, it should 
be confined to those cases in which the pulse is full and strong, the 
temperature very high, and the skin and mucous membranes very dry 
and injected, and it should be given only for a short time, at an early 
stage of the disease. Courter-irntation is not much to be relied upon. 
When there is severe pain in the side, a mustard plaster is of service. 
Blisters are seldom or never to be recommended, certainly not in the 
acute stage. If resolution comes on very slowly, and there is persist- 
ent pleuritic pain, an occasional flying blister will be of service. Calo- 
mel is not to be recommended except as an occasional aperient. If the 
pneumonia is complicated with bronchitis, and the bronchi contain much 
mucus, a stimulant expectorant is indicated, such as : 

314. R. Ammonii carbonatis, gr. viij-xij 

Tincturae scillae, tt^xx 

Syrupi, f. % ij 

Decocti senegae, q. s. ad f. ^ij. M. 

Two teaspoonfuls for a child three years old. 

During convalescence, the use of iron, in a mild form, is of service, 
as : 

315. R . Ferri et quiniae citratis, 9 j 

Syrupi limonis, f-^ij 

Aquae, q. s. ad f.^ij. M. 

Two teaspoonfuls thrice daily. 

EUSTACE SMITH, M. D., M. K. C. P., ETC., LONDON. 

316. R. Liquoris ammonii acetatis, f-3^ v 

Potassii nitratis, 3j 

Potassii bicarbouatis, 3^ ss 

Spiritus aetheris nitrosi, f. % iss 

Aquas carui, q. s. ad f . ^ vj . M . 

A tablespoonful every third hour for a child six or seven years old, in 
cases of "pulmonary phthisis." At the same time, the chest should 



278 DISEASES OF CHILDREN. 

be kept covered with hot linseed-meal poultices, frequently renewed, 
and the child confined to his nursery or bedroom. 

After the cough has become loosened, and the oppression of the chest 
has subsided, expectorants should be given with an alkali: 

317. R . Spiritus ammonise aromatici, 

Spiritus setheris nitrosi, 

Vini ipecacuanha, aa f-.oj 

Potassii bicarbonatis, £j 

Infusi calumbfe, q. s. ad f. jfvj. M. 

A table spoonful every sixth hour. 

Afterward, when the secretion is free, easily brought up, and the 
fever has disappeared, an astringent is useful, combined with expecto- 
rants and a little opium. 

318. R . Liquoris ferri pernitratis, 

Acidi nitrici diluti, aa f. £ j 

Tinctures opii camphoratse, f. 3 ij 

Oxymellis scilhe, f. % j 

Infusi calumbae, q. s. ad f. ^vj. M. 
A tablespoonful thrice daily. 

When unabsorbed pneumonic deposits continue, alkalies are ex- 
tremely useful. The inhalation of sprays of weak solutions of bicar- 
bonate, nitrate, or chlorate of potash, promotes expectoration. 

In chronic pneumonic consolidation, irritants are sometimes useful: 

319. R. Oleitiglii, f.jj 

Linimenti saponis, f.gj. M. 

To be rubbed into a limited spot on the chest twice a day till pustula- 
tion, and then once a day for a week. 

So long as there is much heat of the skin, counter-irritants should 
not be employed. 

PROF. J. LEWIS SMITH, M. D., NEW YORK. 

In the earlier stages, the following is a useful formula for a child of 
five years : 

320. R . Tincturse ipecacuanha? compositse, gtt. xyj-xxiv 

Tincturae acoiiiti radicis, gtt. xvj 

Syrupi tolutaui, 

Aquam, adf. 5J. M. 

One teaspoonful every three hours. 

In the second stage — that is, when there are signs of lung hepatiza- 
tion, such as bronchial respiration and dullness on percussion — aconite 
and veratrum viride do harm. The following may then be employed : 



PNEUMONIA. 279 

321. R • Morphise sulphatis, gr. j 

Syrupi ipecacuanhse, f. % j 

Syrupi tolutani. f. % iij. M. 

Teaspoonful every three hours. 

In feeble children, and in secondary pneumonitis, quinine is prefer- 
able to any other agent, for reducing the temperature and pulse, as it 
does so without causing depression. 

LEONARD WEBER, M. D., NEW YORK. 

In simple pneumonia, whether of children or adults, this practitioner 
states (American Journal of Obstetrics, April, 1878,) that he has 
been accustomed to prescribe : 

322. R. Infusi digitalis (3ss of the leaves), f. gvj 

Sodii nitratis, 5J- ^- 

A teaspoonful every two or three hours, to a child of ten, when the pulse 
and temperature are high. 

When there are signs of the heart giving out, camphor, carbonate of 
ammonia, and wine, are required. Protraction of resolution in the 
lung is often caused by a state of acute anaemia, and demands a liberal 
diet, the discreet use of stimulants, and iron. 

In severe and extensive broncho or catarrhal pneumonia, a most valu- 
able resource is the hot mustard bath. 

As soon as pneumonia develops, in cases of capillary bronchitis, the 
temperature rises to 103°, or more, in a few hours, the pulse beats 
fast, the face becomes flushed, the child is exceeding restless, wears an 
anxious expression of countenance, but soon becomes apathetic and 
somnolent. The course of the disease is rapid, and ends fatally, by 
cyanosis. He immerses the patient in a hot mustard bath (105°), pre- 
pared by diffusing a pound of mustard in a baby-tub full of hot water, 
keeping the child in ten minutes, making thorough friction all over the 
surface, until the skin becomes pinkish. Then the patient is put in a 
warmed bed. If necessary, repeat in four hours. Its modus of action 
is u ubi irritatio, ibi affluxus " — it relieves the congested lung and over- 
burdened heart, by increasing the amount of blood in the peripheral 
circulation; also by stimulating, reflexly, the vaso-motor centres. 

It may be claimed for the use of the bath, that it is easily prepared ; 
that the materials for it can be procured in the household of the poor 
as well as the rich ; that its action is prompt ; that there is no danger 
whatever, in applying it as often as the urgency of the case may require 



280 DISEASES OF CHILDREN. 

it, and that it is a valuable means of fulfilling the vital indication in 
severe cases of pneumonia in children. 

Q. C. SMITH, M. D., CALIFORNIA. 

In all acute pulmonic inflammations in small children, this practitioner 
states {Pacific Med. and Sur. Journal, January, 1878,) that he has 
for several years used, with very satisfactory results, the moist girdle, 
as directed by Yogel, of Dorpat ; and he has found the measure 
greatly to promote relief. He manages it thus : A piece of white 
woolen flannel, two yards long, wide enough to cover the patient's 
body from the hips close up under the arm- pits, after being wrung out 
of warm water, so that it will not drip, is closely, but not oppressively 
so, wrapped around the body, and the terminal end secured by two 
small pins. This moist wrapper is snugly covered by a dry one, which 
outer wrapper must be changed as often as it gets wet. The inner 
wrapper should not, ordinarily, be removed for several days, but is to 
be kept moist by applying, as often as necessary, warm water, with a 
small, soft cloth or sponge. In from four to seven days, when the more 
urgent symptoms have been subdued, the moist girdle may be sup- 
planted by a dry one, which should be applied for a few days longer. 
Of course the attendant will not neglect to make use of such other 
remedies and measures as may be deemed necessary in any given case. 



PROLAPSUS ANI 



Prolapsus ani is most common during the first year, though cases are 
quite often met with from two to six years. It is always protracted 
and may last for months or years. Temporary improvement and unex- 
pected relapses are not infrequent. As a rule, reposition and the use 
of the tampon are merely palliative measures, which do not prevent the 
return of the prolapse. In replacing the prolapse (performed best in 
the knee and elbow position) the central portion, which was last pro- 
truded, should be pushed back first, two fingers of the right hand, 
which is covered with an oiled piece of linen, being placed in the cen- 
tral opening of the prolapse and gently pushed upward. If the chil- 



PROLAPSUS AN1. 281 

dren struggle violently, it may be necessary to use chloroform, and then 
introduce a tampon to prevent the immediate recurrence of the pro- 
lapse. Our author has had the best results from the subcutaneous in- 
jection of ergo tin in the perineum and in the immediate neighborhood 
of the anus. In children, one and one-half to three years old, he in- 
jects daily J of a grain of ergotin at once, and distinct improvement is 
usually observed in a week. We may introduce, daily, ice into the 
rectum or use enemata of tannin, alum or other astringents. When all 
these methods fail, surgical treatment alone remains, either excision of 
some folds of skin around the anus (Dupurytren) or punctate cauter- 
ization Avith a fine actual cautery in the immediate vicinity of the anus, 
the action of which is intended to penetrate to the external sphincter. 
In every method of treatment, we should see to it that the children dis- 
continue violent straining. The prolapsus occasionally remains absent, 
if the faeces are passed while lying in bed, as the abdominal pressure 
acts much less vigorously, and he theiefore advises that the children be 
not allowed to sit on the chamber in the usual manner, with the feet 
braced against the floor, but that the vessel be placed on a firm chair or 
table, and the children be held firmly upon it, with the feet hanging 
loosely. If the patient is constipated, the passages should be softened 
by purgatives ; while, in the event of a protracted diarrhoea or dysen- 
tery, the successful treatment of these conditions may suffice to relieve 
the collapse. 

ARCHIVE DB PHARMACIE. 

In this journal (1882), a physician reports most satisfactory results 
from the use of suppositories, containing from two to three grains of 
ergotin. He remarks that the effects of this remedy were almost mi- 
raculous ; after the application of a few suppositories, the ailment was 
cured. 

NOTES ON REMEDIES. 
Opium. Two minims of laudanum in water three times a day, along with an 
astringent lotion locally, has been used with some success by Mr. Scott 
Battams {Med. Times and Gazette, 1882). 



282 DISEASES OF CHILDREN. 



RACHITIS (RICKETS). 

EDWARD ELLIS, M. D., LONDON. 

Fresh air, abundant and nutritious food, and frequent bathing, are 
measures always demanded in this disease. Tepid salt-baths followed 
by friction with a towel over the whole body are most useful. Bleed- 
ing, blisters or mercury are never to be thought of. Of medicines none 
is more valuable than cod-liver oil combined with an equal portion of 
lime water, and the compound syrup of the phosphate of iron, f.5j every 
day. To check the extreme perspirations which often occur, tannin, 
gr. J-j, thrice daily, or belladonna, may be given. For the diarrhoea, 
a gentle purge, as rhubarb and soda, with some carminative, or a dose 
of castor oil, will be useful. 

P. BRYNSBERG PORTER, M. D., NEW YORK. 

In the treatment, aside from the regulation of the diet and the im- 
provement of the hygienic conditions of the child (which are, of course, 
matters of vital importance), there are no remedies which, in the 
opinion of this physician, are to be compared to cod-liver oil and the 
syrup of the iodide of iron. They should be intermitted from time 
to time, and especially if diarrhoea occurs, as it not infrequently does 
in rachitis. Where they are not well borne (and such cases are ac- 
cording to his experience very rare exceptions), an emulsion of cod- 
liver oil with bitter almonds, to which the hypophosphites of lime and 
soda are added, will often be found an excellent substitute ; and it has 
the advantage of usually not affecting the bcwels unfavorably when 
diarrhoea is present. It is a mistake to be too sparing of the oil, and. 
teaspoonful doses several times a day can be borne by quite young 
children. 

C. CURRIE RITCHIE, M. D., MANCHESTER. 

The treatment of rickets requires as its essential condition the resto- 
ration of a healthy nutrition — hence diet and hygienic measures are of 
the utmost importance. Regular feeding at stated intervals; abund- 
ance of milk with a fourth part of lime water, and the addition of a tea- 
spoonful or two of cream to the half-pint ; as the child gets older, a 
little beef tea with bread, eggs, or light puddings ; if potatoes be given, 
they must be finely mashed with a little meat gravy ; after eighteen or 



RACHITIS (rickets). 283 

twenty months, meat twice a day, or strong soup in small quantities — 
these are the chief dietetic indications. 

Daily tepid chalybeate or salt-water baths, plenty of warm woolen 
clothing, warm but well-ventilated rooms, and as much dry open air 
(the bracing sea-air to be preferred) as practicable, are points which 
will at once suggest themselves. 

As to strictly medicinal treatment, it has for some time been the 
stereotyped phrase in our text-books — "There is no specific remedy for 
rickets." 

Cod-liver oil is one of our most important remedies. Its efficacy is 
greatly enhanced by a combination with iron. The j^tosjpJiate of iron 
is the preparation which Dr. R. has found most benefit from ; it may 
be given either as the simple syrup, or in the form of Parrish's com- 
pound syrup of the phosphates ; in private practice he has found chil- 6 
dren take it remarkably well with the cod-liver oil. 

Of course, before administering cod-liver and iron, we must see that 
the motions have become healthy and the tongue clean. Dr. R. usually 
employs Sir Wm. Jenner's plan for this purpose, viz.: to give a single 
dose of an aperient, such as a teaspoonful of castor oil, or a little gray 
powder with jalap, even though the bowels should be rather loose — as 
the stools are frequently most offensive, from the acidity which is 
always present in these cases, and which is relieved by an occasional 
dose of rhubarb, with soda or magnesia. 



This author agrees with all other writers on this subject, in stating 
that the greatest attention must be paid to hygienic conditions, and to 
the feeding of the infant. A wet-nurse should be substituted if the 
mother's milk is deficient either in quantity or quality, or carefully se- 
lected cow's milk may be provided. The most nutritious and digestible 
diet must be given after the child is weaned, and especially a diet con- 
taining a large amount of animal food. In rickety children, the teeth 
are generally defective, and as complete mastication is often impossible, 
their meat should be finely chopped and bruised in a mortar. The 
child should be taken out daily in the air and sunlight, and it should 
be suitably and warmly clad. Salt water baths may be given with 
benefit. 

Impaired digestion and diarrhoea may call for vegetable tonics, iron 



284 DISEASES OF CHILDREN. 

preparations, antacids, and mild astringents. Cod-liver oil should 
always be given, either alone or in combination with vegetable tonics 
and iron preparations. The cod-liver oil may be rubbed into the axillae, 
or the groins, if its internal administration is attended with difficulty. 
The oil will sometimes be better tolerated when given in the form of 
emulsion, or when combined with lime-water. 

To prevent deformities, the child should lie upon a smooth, firm mat- 
tress ; no high pillows should be allowed, and, until the bones have be- 
come inflexible and firm, no sitting up ior any length of time, or at- 
tempts at walking, should be permitted. During the earlier stages of 
the disease mechanical contrivances are not advisable, but during con- 
valescence attemps should be made, by means of paste-board or leather 
splints, to control the deformities. 

DR. EDWARD HENOCH, OF BERLIN. 

This author maintains that we are unable to furnish a scientific basis 
for treatment, and must be satisfied that we almost always prove suc- 
cessful with empirical remedies. After insisting on the necessity of 
good hygienic surroundings, he says that to him it appears absurd to 
forbid the use of milk (as some do), since this interdiction is founded on 
some unreliable experiments concerning the injurious influence of lactic 
acid. In the large majority of cases of rachitis, recovery ensues de- 
spite untoward external circumstances, unless tuberculosis or some 
other complication occurs, or the general cachexia has reached too high 
a grade. He begins treatment with the milder preparations of iron, 
especially tincture of the chloride, eight or ten drops three times a day ; 
if this (as he has sometimes observed) produces diarrhoea, he substitutes 
ferri lacticum or reductum (gr. ss-j twice daily). As a matter of 
course, the digestive organs must be in good condition in order to tol- 
erate the iron. If anorexia, coated tongue, constipation or diarrhoea 
is present, he gives first hydrochloric acid, then mild bitters, espec- 
ially tinct. rhei vinosa (10-12 drops three times a day), and the latter 
may be combined with iron. On alternate days, a lukewarm bath 
should be given, with the addition of salt or infusion of malt or aro- 
matic herbs (about a handful of chamomile or calamus) and the lower 
limbs should be rubbed and kneaded with flannel in the bath, as well 
as several times during the day. We should persistently wash the 
occiput in order to relieve the profuse perspiration, and if there are 



RACHITIS (rickets). 285 

softened spots in the occipital bone, the head should be rested on a 
hair pillow, with a hole in it, in order to protect the part in question 
from pressure. Cod-liver oil he only gives in cool weather, chiefly in 
emaciated children, and never more than two tablespoonfuls daily, 
either alone or in combination with preparations of iron. He has never 
seen any good results from the administration of lime salts, and has long 
since discontinued their use. 

DR. JOHN M. KEATING, OF PHILADELPHIA. 

This authority on diseases of children says {Medical and Surgical 
Reporter, 1883), that in the treatment of these cases, your first 
thought should be as to their hygienic condition and surroundings ; and 
see to it that these are as perfect as circumstances will permit. 

Food next calls your attention. If the child is still nursing, exper- 
ience will tell you that there is no food so well adapted to its use as the 
maternal milk, provided, of course, that the supply is sufficient and of 
proper quality, and that the mother is healthy. As the child grows 
older, its diet must still be uppermost in your plan of treatment. 

We have no medicinal agent which acts as a specific in this disease 
(as iodine and mercury do in the syphilitic diathesis), but we must ex- 
hibit our drugs in order to meet special indications. Lime-water meets 
the condition of the gastro-intestinal tract, and also supplies the bones 
with the needed material. A good plan is to give it with the milk. 
Cod-liver oil should be your sheet-anchor to prevent emaciation. Give 
it either internally or by inunctions ; the latter method acts marvel- 
ously in these cases. 

Iron, as the tinct. of the chloride, must also be supplied as an 
haematic, and for its restraining property on the bowels. 

Salt sea baths, among the rich, are good adjuvants to general treat- 
ment. 

PROFESSOR F. FORCHHEIMER, OF CINCINNATI. 

This author tells us that we must regulate the diet {Archives of 
Pediatrics, 1884.) Give milk and broth principally as food. Add 
salt to all the food you give the patient. Regulate the bowels. If you 
find that the child is constipated, you can often secure daily evacuations 
by some change in diet. If diarrhoea be present, treat it as you would 
any other catarrhal affection of the bowels. Every patient with rickets 
ought to receive a tepid or cool salt water bath every day. The bath 



286 DISEASES OF CHILDREN. 

ought to be made by adding a handful of ordinary fish-salt to the bath. 
When the child comes out of it he is to be rubbed thoroughly with a 
towel, rough, if the child be old enough. Have the patient sent out 
into the fresh air every day ; you can protect them against the inclem- 
encies of the weather, but give them fresh air. Here, however, you 
must take precautions in that you may cause deformity. In order to 
prevent deformity, you will teach the child's attendants how to handle 
it — one hand under the nape of the neck and the other under the but- 
tocks. If there is any danger of deformity of the spine, you must 
send the child out, resting on a pillow, in a perambulator or upon the 
arms of a nurse. Do not permit any attempts at walking until you are 
positive that the disease has run its course in the legs. His indications 
for the use of cod-liver oil are as follows : if a child is very thin, and 
over six months of age, you can begin carefully with small doses. 
Never give this remedy until you are positive that your patient has di- 
gestive organs that will bear the remedy. The oil sometimes acts very 
well, not only as to causing an increase in the child's weight, but also 
in regulating the bowels. The great objections to this remedy are, 
that it produces dyspepsia or intestinal catarrhs. You must not, how- 
ever, think that because a child increases in weight it is improving ; fat 
children frequently suffer with rickets. Neither must you prescribe 
cod-liver oil in every case of rickets, because it was once looked upon 
as a specific. The lime water also, in some cases, acts very well, but 
he believes with Baginsky, that its action is due, not to any specific 
properties, but simply because of its effect upon the milk. You will 
find it necessary in some cases to give iron preparations ; and, in chil- 
dren over one year of age, when there is an appreciable tumor of the 
spleen, very small doses of arsenic are not only well borne, but seem to 
act beneficially both upon digestion and blood-making. Of the compli- 
cations, it is necessary to speak, in detail, only of one — laryngospasmus 
or laryngismus stridulus. Against this much- to-be-dreaded complication 
you may use the bromides, chloral, or, if necessary, hypodermic injec- 
tions of morphia. The parents and attendants are to be impressed with 
the physical and psychical treatment of their children ; they must be told 
that a scolding or fright, or anything that may act suddenly upon the 
child, can produce an attack whose determination is always a matter of 
doubt. All other complications will be treated as indications may call 
for; never, however, neglect the anti-rhacitic measures. 



RETROPHARYNGEAL ABCSESS. 287 

NOTES ON REMEDIES. 

Aqua Ualcis, with milk, or cod-liver oil, is useful to prevent acidity and diarrhoea. 

Calcii Lacto-phosphas. M. Dusart finds that in every case in which the diet, 
though sufficient in quantity, was unsuited to the digestive organs, the 
addition of lacto-phosphate of lime caused rapid improvement. Very 
interesting observations upon this subject have been collected in the 
large hospitals of Paris. (Gazette Medical de Paris, March, 1879). 

Calcii Sulpho-carbolas. Dr. Ernest Sansom says he has used this "calcium 
salt (which is one of the most soluble known) in rickets . . . with 
uniformly good results, in doses of three to five grains, or more." 
Others who have tried it have been disappointed with it. 

Ferrum, either as the phosphate or the iodide, is esteemed by all writers. Dr. 
Aitken recommends : 

323. R. Viniferri, f-3j-ij 

Quinise sulphatis, gr. j 

Acidi sulphurici diluti, n\J— ij. M. 

Oleum Morrhuce is almost indispensable. Dr. William Goodell recommends 
it in small doses (gtt. xx, to an infant ; but Dr. P. B. Porter believes 
much larger amounts may be taken with advantage. If any of the oil 
is passed by stool, the quantity should be diminished. 

Phosphorus. Bartholow says that since phosphorus induces an hypertrophy 
of bone tissue, it should be carefully tried in this disease. It may be 
advantageously given in cod-liver oil. 

Dog** Milk has been found by Dr. Bernard, of Monttrum, France, to be the 
best of aliments in rickets. ( Gazette Hebdomadaire, 1877). 



RETROPHARYNGEAL ABSCESS. 

DR. EDWARD HENOCH, OP BERLIN. 

There is only one remedy, viz.: rapid incision. This author per- 
forms this operation with a straight, or, when the abscess is situated 
deep, curved bistoury or tenotome, which is surrounded with adhesive 
plaster nearly to the tip. -The child's tongue is depressed with the 
left index finger, so that its tip touches and distinctly feels the tumor, 
the head being firmly held by an assistant. The finger is used as a di- 
rector, the knife carefully carried along to its tip, i. e., to the tumor, 
and then boldly plunged into the latter, whereupon the pharynx is im- 
mediately filled with yellow pus ; the little wound is enlarged in with- 
drawing the knife. In order to facilitate the discharge of the pus, the 



288 DISEASES OF CHILDREN. 

head of the child should immediately be inclined forward. After the 
incision, all is usually at an end, and complete euphonia is at once pre- 
sented. Sometimes the abscess will have to be opened a second or even 
a third time. After the incision it will be well to use repeated injec- 
tions of lukewarm water into the nasal and pharyngeal cavities, in order 
to clear out the blood and pus. If the operation is not performed in 
time, spontaneous rupture may occur during sleep, with aspiration of 
pus into the air-passages, and fatal suffocation. Or the pus may pass 
down behind the pharynx or oesophagus even into the mediastinum, and 
death occurs finally from exhaustion. 



RHEUMATISM 



DR. EDWARD HENOCH, OF BERLIN. 



Acute articular rheumatism is by no means rare in childhood, and is 
only distinguished from that occurring in adult life, by the milder char- 
acter of its symptoms. In acute cases he employs, with the same suc- 
cess, as in adults, either salicylic acid or salicylate of soda, the latter 
especially in chronic cases. 

DRS. MEIGS AND PEPPER, OF PHILADELPHIA. 

The indications for treatment presented by acute rheumatism have 
been universally recognized as uniform, but the measures adopted to 
meet them embrace almost all known remedies. 

The formula which our authors are in the habit of using is : 

324. R. Potass, acetat., 3J 

Potass, bicarb., 3 j 

Tr. opii deod., gtt. xxiv 

Vel. tr. opii camph., f. £ ij 

Syr. zingiberis, f. ^ j 

AquaB, q. s. ad. f.3 iij. 

Ft. Sol. S. — A teaspoonful every two or three hours, at four or five 
years of age. 

When the fever is very marked, nitrate of potash may be substi- 
tuted, in carefully graduated doses, for the bicarbonate. Iron, par- 
ticularly in the form of Basham's mixture, should be given as soon as 
the intensity of the fever has been mitigated. When the acute symp- 
toms have subsided, the alkalies may be withdrawn, and quinia in com- 
bination with opium given — as : 



RUBEOLA (MEASLES). 289 

325. R. Quinise sulph., gr. xxiv 

Liq. morph. sulph., f-3U 

Acid, sulph. dil., gtt. xxx 

Ouracoa, f. 5 ij 

Syrupi, f. gvj 

Aquas, q. s. ad f. ^iij. M. 

Ft. Sol. S. — A teaspoonful every four hours at four or five years of age. 

If the pain is very great, a small and mild blister may be used with 
advantage, or the joints may be bathed with the following: 

326. R. Tinct. opii deod., 

Tinct. aconiti rad., aa f-olj 

Lin. chloroformi, f. 3 jss 

01. olivas, q. 5. ad f.giv. M, 

Et. Ft. lin. 

And then enveloped in wool and covered with oiled silk. 



RUBEOLA (MEASLES). 

DR. W. B. POWELL, OF LOUISIANA. 

This author's treatment for ordinary cases of measles is as follows 
{Medical and Surgical Reporter , 1881) : 

327. R. Morpln'33 sulph., gr. j 

Liq. calcis, 

Aquae menth., aa f. J j. M. 

S. — One to two teaspoonfuls, according to age, every hour, until relieved. 

When dysenteric symptoms are present, he orders: 

328. R . Pulv. opii, gr. ij 

Bisrauthi subnit., 9J 

Salicin., gr. vj. M. 

Excipienti q. s. ut ft. pil. No. iv. 
S. — One pill every two hours until bowels are quiet. 

DR. WILLIAM M. POLK, OF NEW YORK. 

This clinician Med. and Surg. Reporter, 1880), confines himself, as 
a rule, to meeting symptoms as they arise. It is a self-limiting dis- 
ease, and one, which under ordinary circumstances, will get well. Of 
course, if the child have a laryngitis or a bronchitis, or a pneumonia, 
there is danger of a fatal termination, or at any rate, the prognosis is 
not so good. When such complications arise, the indications for treat- 
19 



290 DISEASES OF CHILDREN. 

ment are such as belong to them respectively. In a case of simple 
measles, put the child to bed. to insure warmth and protection ; keep 
the bowels open, by some mild laxative, as castor oil, if the child will 
take it ; then support it by nutritive food, such as is easily digested. 
Stimulants are indicated only by the condition of the pulse. 

Where the pulse indicates heart failure, stimulants are to be used, 
otherwise not. Cough is very frequently an obstinate and a trouble- 
some symptom, particularly in the earlier stages, and the cough has 
something characteristic about it. It is a dry, hacking, constant cough. 
The best treatment is local applications to the throat, because the cough 
is due entirely to the condition of the pharynx. The local application 
which insures the best results is some astringent wash, as tannin and 
glycerine or lime and glycerine. It is important to protect the child 
from exposure for some time after the eruption' has subsided, because 
as long as there is that scurfiness of the skin which indicates desqua- 
mation, we may be sure that the mucous membrane is in a condition in 
which it will readily take on inflammation. He would keep the child 
indoors for at least four weeks from the time that the symptom made 
its appearance. As soon as the redness of the skin has subsided, and 
before desquamation is complete, there is no objection to the child tak- 
ing a bath, in order to hasten desquamation as much as possible. If 
there be excessive irritation of the skin, as there often is, the local ap- 
plication of vaseline to the skin will have a tendency to check it. Oil 
the child from head to foot with ordinary vaseline. 

DR. EDWARD HENOCH, OF BERLIN. 

According to this author the disease merely requires, in the way of 
treatment, that the patient be kept in bed, (the room being kept 
warm), with light covering and a diet consisting of milk, soup and cool 
drinks as long as the high fever lasts. The room should merely be 
darkened to an extent agreeable to the child. He does not consider it 
advisable to isolate the patient from his brothers and sisters, on account 
of the slight danger and the certainty that the children will become af- 
fected sooner or later ; he would only endeavor to secure very young 
or sick children, against infection. No medicinal treatment is required 
in simple cases. If the cough is violent, we may order infusion of 
ipecac root, and perhaps a fly blister about an inch long over the trachea. 
If diarrhoea becomes profuse and the passages occur four to six times a 



RUBEOLA (MEASLES). 291 

day, or even more frequently we may relieve it with inf. rad. ipecac 
and opium. 

329. R. Inf. rad. ipecac, f.^iij 

Mucil. gum arab.. 

Syr, simpl., aa f«5ij. ss 

Tiuct. opii, gtt. ij. iv. M. 

S. — Dose, a dessertspoonful. 

DR. Q. C. SMITH, OF TEXAS. 

The treatment recommended by this practitioner in the Nashville 
Journal of Medicine and Surgery, 1881, is as follows: He reduces 
the temperature by tepid ammoniated baths — a tablespoonful of strong 
aquae ammonia to each gallon of water — repeated as often as necessary 
to keep the temperature quite normal. The patient should remain in 
the bath from five to fifteen minutes, being well rubbed during the 
time. Just before being removed from the bath, one or two gallons — 
according to the intensity of the fever — of drinking-cold water is poured 
over the patient's head in a full stream, the patient quickly removed 
from the bath and wrapped in a dry blanket, and allowed to rest quietly 
for twenty or thirty minutes. Then, without removing the coverings, 
the patient is gently, but thoroughly embrocated over its whole person 
with camphorated vaseline, repeating the embrocation after each bath. 
Should the case be so light, that bathing is not deemed necessary, the 
camphorated vaseline embrocation is repeated three or four times a day. 
For internal medication, he uses : 

330. R . Ammonise carb., 

Lithii bromid., aa 5 ss 

Liq. ammonii acetat., q. s. ad. f.gj. M. 

S. — Teaspoonful in a little sweetened water, every one to three hours. 

For the throat trouble, put a few grains of pure dry bisulphite of 
soda in the patient's mouth every few minutes ; let it slowly dissolve 
and soak down the throat. When the patients are too large to handle 
in a bathing tub, he substitutes the sponge bath. He allows all the 
cold water, lemonade, milk and fruits (in small quantities at a time), 
that are desired. 

PROFESSOR M. CHARTERIS, M. D., GLASGOW. 

Measles is an essentially dangerous disease in infancy and in old age, 
though the danger is not in the disease so much as the sequelae it leaves 
behind it. 



292 DISEASES OF CHILDREN. 

• 

All exposure to cold must be avoided. The room should be dark- 
ened and the patient kept in bed. Mild diet is advisable and a light 
diaphoretic mixture, as : 

331. R. Vini ipecac. f. giss 

Syrupi, . f.gss 
Tinct. camphorse comp., f. 3ilj 

Liquoris ammonise citratis, f. £ ss 

Aquam, adf. jij. M. 

A teaspoonful every two hours. 

When the cough is troublesome, an emetic often gives relief; and 
for the diarrhoea, cold compresses may be applied to the abdomen. 

In "black measles," which is the hemorrhagic form of the disease, 
and a very fatal complaint, the system must be actively supported by 
wine or brandy, and the bronchi kept clean by stimulating expec- 
torants. 

HIRAM CORSON, M. D., PENNA. 

This practitioner has practiced and advocated for many years the 
cooling treatment of measles. {Medical and Surgical Reporter, vol. 
xxvi.) He allows the child abundance of cool or cold water to 
drink, opens the windows to allow free ventilation, keeps the tempera- 
ture of the apartment low, and if the heat of skin be excessive, sponges 
the body frequently with cool or tepid water. Internally, small doses 
of neutral salts to move the bowels are all that are generally required. 
Ice is given ad libitum, to allay thirst. 

By this method he believes the dangerous complications are pre- 
vented, and a light eruption of the skin is secured. 

DR. DAVIS, NEW YORK. 

This writer {Medical Record, July, 1871,) considers the following 
formula one of the best preparations in the first stage of severe cases 
of measles : 

332. R. Syrupi sciHae comp., f.^iss 

"V ini antimonii, f. ,^ ss 

Tiuct. opii camphoratae, f.g ij 

Tinct. veratri viridis, f. 3 ij M. 

One teaspoonful every three hours in water. 

If the bowels are costive, they should be moved by a mild laxative. 
When symptoms of pneumonia arise, they may be met with the 
following : 



EUBEOLA (MEASLES). 293 

333. R . Liq. ammon. acetatis, f. 3 iss 

Syrupi ipecac, f. j^ss 

Tinct. opii campliorat., f. % j 

Tinct. veratri viridis, f. £j M. 

Ten drops every two or three hours, for a child a year old. 

The chest should be covered with fomentations. 

NOTES ON REMEDIES. 

Aconite, according- to Bartholow, possesses the power of arresting the catarrhal 
. pneumonia, which is one of the most serious complications of this dis- 
ease. 
Ammonii Acetatis Liquor. An excellent diaphoretic. Dr. Aitken prescribes : 

334. R. Liq. ammon. acetatis, f • 3 j 

Spiritus setheris nitrici dulcis, TTLx-xx 

MistursB camphorae, f.^ss M. 

To a child six years old every four or six hours. 

Ammonii Carbonas. Mr. Erasmus Wilson recommends that as soon as an at- 
tack of measles is suspected, the patient should have a mild purge, 
followed promptly by gr. v of carbonate of ammonia every two or three 
hours, in water, broth or milk. 

Aqua. Cold water is given to any extent by recent practitioners. For the 
laryngitis which often develops, a sponge may be wrung out in very hot 
water and applied to the throat. For the rather common and some- 
times very perilous epistaxis, water, as hot as it is possible to bear, con- 
taining a few grains of sulphate of zinc to the ounce, is used by Dr. 
Jaccoud, of Paris. 

Nitricum Acidum, and other mineral acids, are useful in the hemorrhagic 
variety ; gtt. xv to water Oij, may be given as a drink. 

Potassii Bromidum is called for when there is sleeplessness and nervous excita- 
bility. 

Potassh Chloras, in large doses, with stimulants, is recommended by Dr. Ellis 
when the fever is of low type, with brown tongue and failing powers. 

Quinine, according to Bartholow, is highly useful for the adynamia, and in large 
doses when catarrhal pneumonia comes on. 

Veratrum Viride is used by Dr. Davis to reduce the febrile symptoms in severe 
cases (F 332.) 



294 DISEASES OF CHILDREN. 



SCARLET FEVER. 



PROPHYLAXIS OF SCARLET FEVER. 



Of asserted prophylactics, belladonna easily stands at the head of 
the list. The testimony regarding it is very conflicting. On the one 
side, Prof. J. Lewis Smith believes, from the weight of evidence, that 
it is entirely inert. Dr. Andrew Wood, at Heriot's Hospital, Edin- 
burgh, and Dr. Alley, at the Orphans' Asylum, Boston, experimented 
with it, administering it to one-half the children in their institutions, 
and, to use the words of the latter, " there was no manifest difference 
between the two classes as to susceptibility to the contagion ;" and 
Thomas, in his exhaustive article in Ziemssen's Cyclopedia, speaks of 
belladonna as the "much-vaunted pseudo-prophylactic." 

On the other hand, Rilliet and Barthez think it worthy a trial. 
Professors Meigs and Pepper think favorably of it. Dr. McK.ee, of 
South Carolina, thinks he used it with success. Dr. Porcher, after a 
review of four hundred volumes of literature Qn the subject, expresses 
himself in favor of it ; and Professor Stille, after reviewing the whole 
subject, says: " We feel bound to express the conviction that the vir- 
tues of belladonna, as a protection against scarlatina, are so far proven 
that it becomes the duty of practitioners to invoke its aid whenever the 
disease breaks out in a locality where there are persons liable to the 
contagion — particularly in boarding-schools, orphan asylums, and simi- 
lar institutions, and among the families of the poor ; whenever, in a 
word, it is difficult to place the healthy at a distance from the sick." 
Dr. Charles W. Earle, of Chicago, from an extended experience in 
that city, reached the conclusion that although its administration does 
not prevent children taking the disease, it mitigates the character of 
the attack. 

The bisulphites and hyposulphites of soda and magnesia come 
next in importance. They may be given in solution of syrup and 
water, gr. f-j, for each year in the child's age, four times daily. Re- 
cent and strong testimony to their efficacy has been added by Dr. G. 
H. Harman. (Ohio Medical and Surgical Journal, April, 1878.) 

Tonic doses of tinctura ferri chloridi during an epidemic have been 
found by Dr. J. A. Larrabee, of Kentucky, to exert a protecting in- 
fluence. He believes that the action of the iron directly upon the 



SCARLET FEVER. 295 

blood will prevent the scarlatinal poison from involving the system. 
{Trans, of the Kentucky State Medical Society, 1865.) 

The sulpho-carbolate of soda has been urged on theoretical grounds 
by Drs. Samson and Brackenrldge, to persons exposed to the poison 
of scarlet fever, and the latter relates several striking instances of what 
he believes to be its protective powers. He gives the salt in doses of 
gr. v-xxx, three or four times daily. Its use in this country has not 
answered expectations, and it has rather been found to depress the vital 
powers and tend to cause the patient to succumb. 

The value of inunction as a prophylactic has been prominently set 
forth by Prof. James B. Walker, M. D., of Philadelphia. {Med. 
and Surg. Reporter, August 23, 1879). He believes that patients 
anointed several times daily with fat bacon, warm sweet oil, or similar 
fatty preparation, become, in a great degree, unable to propagate the 
infection, as the epidermic scales, which are generally conceded to 
spread the poison, are, by this means, prevented from escaping into the 
surrounding atmosphere. 

For prophylactic purposes, Dr. John C. Peters, of New York, re- 
lies upon sweet spirits of nitre. {Medical Gazette, July, 1869.) It 
lessens fever and prevents, by its diuretic action, the occurrence of dis- 
ease of the kidneys. It may also eliminate the poison so rapidly and 
completely that the system cannot become affected, nor the disease 
reach its full development. 

Complete and continuous isolation is probably the only sure safe- 
guard against infection. 



In moderately severe and grave cases, the external treatment should 
be by cold applications to the head and sponging to the face and arms. 
This may be frequently repeated. Immersion in cold water or pour- 
ing it upon the person is questionable, as such a shock may increase 
the liability to chronic convulsions. 

The itching of the skin should be relieved by inunction. The best 
substitute for this purpose is sweet oil or glycerine, to each ounce of 
w r hich six or eight drops of carbolic acid are added. [Other authors 
commend, as still better, cocoa butter, theohroma cacao, which has a 
marked cooling effect.] The inunction should be made with linen or 
muslin, and the substance should be applied frequently to those parts 
of the surface which itch. 



296 DISEASES OF CHILDREN. 

As an internal remedy, carbonate of ammonia is one of the best : 

335. R. Ammonii carbonatis, 

Ferri et ammonii citratis, aa gss 

Syrupi simplicis, f-S^ v - M. 

A tablespoonful every thee hours, to a child three years old. 

In the malignant forms of the disease, with the temperature at 105°, 
drowsiness, delirium and restlessness, the sulphate of quinine, in full 
doses, is more useful than any other remedy ; gr. iij-v, thrice daily, to 
a child of five years. If the stomach will not retain it, give doses of 
gr. xij by enema. A hot mustard-bath or foot-bath develops the rash, 
and allays nervous excitement ; it is especially indicated if the convul- 
sions occur attended by disappearance of the eruption. 

For the pharyngitis, a slice of salt pork, cut thin, and stitched to a 
single thickness of muslin, should be applied to the throat. It should 
pass from ear to ear. This application should be continued throughout 
the fever, being left off for a day or two, if too much soreness is in- 
duced. It is a gentle and eifectual counter-irritant. Local applications 
to the fauces are still more important : 

336. R • Acidi carbolici, gtt. xv-xxx 

Potassii chloratis, 9 "J 

Glycerinae, 

Aquae, aa f. ^iij. M. 

For a gargle. 

337. R. Acidi carbolici, gtt. v 

Liquoris ferri subsulphatis, f. ,^ij 

Glycerinae, f.gj. M. 

To be applied with a camel's-hair pencil, three or four times daily. 

Yeast is useful in many of these cases, given in doses of f.5ss-f.5j, 
several times a day. No drink should be allowed for several minutes 
after swallowing it. 

HIRAM CORSON, M. D., NORRISTOWN, PA. 

This writer has, for several years, been a prominent champion of the 
ice and cold-water treatment of scarlatina, advocated, early in this cen- 
tury, by Dr. James Currie, of London, and later by Professor Trous- 
seau, of Paris. 

He applies the ice in moderate quantities, tied up in two small pieces 
of bladder, and one placed on each side of the neck, over the parotid 
gland, and retained by a strip of muslin brought under the jaw and tied 



SCARLET FEVER. 297 

on the top of the head, not around the neck. If no bladder nor gutta- 
percha bag can be procured, fold a strip of old muslin twice, so that, 
when thus folded, it shall be three inches wide, and long enough to ex- 
tend from the bottom of one ear, under the jaw, to the bottom of the 
other. To each end of this, sew a strip of muslin of the same width, 
and a foot or more in length, by which, when applied, it may be tied to 
the top of the head. Have a line of stitches run crosswise through the 
middle of the fold ; there will then be a pocket for ice on each side of 
the neck. For the first application, wet this with cold water alone, and 
tie it on ; after wetting it a few times, slip into the pouch, on each side 
of the neck, three or four large lumps of ice, as large as a shellbark, 
and keep them well stocked with ice. Give the ice freely inside, apply 
it over the nose, and sponge the body and limbs freely with cool or 
cold water. 

STILES KENNEDY, M. D., MICHIGAN. 

According to this writer, two medicines only have gained much 
reputation for mitigating or subduing the symptoms of fever in this dis- 
ease, or the disease itself, and the profession is about equally divided 
as to their respective merits. One is the chlorine mixture, which, for 
ready use, may be prepared about as follows : 

338. & . Potassii chloratis, 3j 

Acidi muriatici, 
Aquae, aa f. ^ j. M. 

From two to eight drops of this to a tablespoonful of water, may be 
given every two hours. For children over eight years of age, a solu- 
tion made of two drachms of the mixture and a pint of water, is strong 
enough to give, in tablespoonful doses. It is generally prepared sweet- 
ened with simple syrup, but, at best, it is an unpleasant dose to many 
children, and often makes them complain of burning in their throats. 

The other medicine alluded to is the liquor ammonii acetatis of the 
Pharmacopoeia. Probably no anti-febrile mixture has stood the test of 
the experience of the profession for so long a time, with so much satis- 
faction, as this, not in scarlet fever particularly, but in all febrile dis- 
eases ; and our author does not remember ever to have heard it com- 
plained of when the vital powers begin to flag. An excess of carbonate 
of ammonia may be added, in the quantity of five or ten grains to the 
ounce : 



298 DISEASES OF CHILDREN. 

339. R. Ammonii carbonatis, Bij-iv 

Liquoris ammonise acetatis, f.^iijss 

Byrupi simplicis, f.gss. M. 

Give from half to a whole tablespoonful, in a little water, every one or 
two hours, according to the age of the patient and the urgency of the 
symptoms. 

FREDERICK T. ROBERTS, M. D. 

In reference to the treatment of special symptoms, this author gives 
the following recommendations : 

The throat symptoms are best relieved by sucking ice or inhaling 
steam. A few leeches about the angle of the jaw are occasiorally ad- 
visable. For ulceration and gangrene, antiseptic gargles are demanded; 
or, if the patient cannot gargle, inhalations or sprays. The antiseptic 
may be either carbolic acid, creasote, chlorate of potash, permanganate 
of potash, or sulphurous acid. 

The nostrils, if blocked up, must be washed out occasionally with a 
weak disinfectant solution. Ulcerations may be touched with a solu- 
tion of nitrate of silver. A weak solution of chlorate of potash may 
be allowed freely as a drink. But in a large number of cases, the 
only hope of recovery lies in the free support of the patient by food 
and stimulants. As often the child cannot or will not swallow, and 
the necessary materials cannot be introduced into the stomach, they 
must be administed by enemata. At the same time, tincture of iron, 
in full doses, n^xx-xl, every three or four hours, with quinine or min- 
eral acids, is called for. 

THE ALBUMINURIA AND DROPSY. 
Dr. W. H. Thompson, of New York, considers that with reference 
to the nephritic complication, no case is to be despaired of in its acute 
stage, for recoveries from apparently the most desperate circumstances 
(as in cases in which urine has continued suppressed for seven and nine 
days), have taken place. The measures to be adopted are oiling the 
skin, the hot-water pack, dry cupping, counter -irritation by means of 
spoons heated in hot water and applied momentarily over the kidneys, 
the free use of the infusion of digitalis, etc., after diaphoresis, large 
injections of warm water. The injections are preferable to purgatives, 
because the action of the warm water favors the discharge of water 
from the bladder. A quart may be perhaps used as many as six times 
a day, and passing the urine may come only with the last injection. 
The infusion of digitalis should be given to children in very nearly as 
large doses as are required for adults. 



SCARLET FEVER. 290 

When purgatives are used, the usual one is elaterium : 

340. B . •Pulveris elaterii, gr. £ 

Pulv. scammon. com^., gr. v 

Potassii bitartratis, 3 ss. M. 

For a child of ten. (E. Ellis.) 

Elaterium is objectionable on account of its tendency to excite vom- 
iting, unless carefully combined. 

Digitalis is the most approved diuretic. It may be given in the 
fresh infusion, or as follows: 



341. B . Tinct. digitalis, rriiij 

Tinct. hyoscyam., tt\,v 
Syr. aurantii, f. % ss 
Aqua3 camphorae, f. % iv. 
This amount for a five-year-old child, every six hours. 


M. 


342. B . Infusi digitalis, % ss 
Potassii acetatis, gr. v 
Sphitus juniper, comp., nr^x 
Decocti scoparii, ad f.gss. 

For a child five years old every six hours. (Dr. Edward Ellis.) 


M. 



The use of iron in as large doses as the system can bear without 
producing headache or nausea is recommended by Prof. M. Charteris : 

343. B • Tincturse ferri chloridi, f. % ij 

Infusi digitalis, f. % vij. M. 

A dessertspoonful thrice daily. 

The diet should be generous, with plenty of milk, and a uniform tem- 
perature insisted upon. 

When convulsions supervene, Dr. S. Wilks, of Guy's Hospital, and 
other leading English authorities, do not hesitate to practice venesection 
to f. giij-vj. In many instances, where every other means failed, pa- 
tients have recovered by the judicious employment of the lancet. 

DR. EDWARD HENOCH, OF BERLIN. 

This author considers that no drugs are required in normal cases 
which are free from complications. The child should be isolated as 
much as possible from his brothers and sisters, or the latter be removed 
from the house. Pure air and cool temperature should be earnestly 
recommended ; the windows should therefore be repeatedly opened, at 
least in the adjoining room, the child covered lightly, and the room 
darkened only when photophobia is present. Cool drinks, milk, soup, 



300 DISEASES OF CHILDREN. 

pigeon or chicken broth should constitute the diet during fever days. 
An enema or a mild purgative every other day — for example, a tea- 
spoonful of magnesia or a laxative effervescent powder ; a wineglassful 
of bitter water, etc., may be given in constipation. If the fever con- 
tinues, high and malignant symptoms develop, the head should be cov- 
ered with an ice-bag, a large close of quinine or salicylate of soda given 
between four and six o'clock p. m., and the child placed in a lukewarm 
bath. He decidedly opposes cooler baths, because in scarlatina, which 
presents a tendency to heart failure, cold may produce an unexpected 
rapid collapse more than in any other affection. But he strongly rec- 
ommends washing the entire body every three hours with a sponge 
dipped in cool water and vinegar. If something must be prescribed, 
hydrochloric acid is the most suitable. 

344. R. Acid, hydrochloric, gtt. £-j 

Aq. destil., f. ^iij 

Gum. arab., gv. xv 

Syrup, f.3v. M. 

S. — Teaspoonful every two hours. 

In truly malignant cases, however, antipyretic treatment proves 
utterly useless. He has never seen any effects from large doses of 
quinine, and he considers salicylate of soda in such cases a dangerous 
remedy. If we can sustain the action of the heart by the use of power, 
ful stimulants until the organism has overcome the other severe conse- 
quences of the infection, we may still hope for a favorable termination 
unless grave complications are present. Among stimulants he gives 
the first place to alcohol (wine, brandy), coffee in large doses, and cam- 
phor. When deglutition is impaired by swelling of the pharynx, a 
nutritive enema of pepton should be given twice a day, or a small cup 
of bouillon with yolk of egg and a spoonful of wine, and a hypodermic 
injection made every three hours of sulphuric ether (a hypodermic- 
syringeful), or camphor, either in the form of camphorated oil, or 
better still, as a solution of camphor in alcohol and water. If the 
malignant form of scarlatina runs its course without any dangerous 
symptoms of heart failure, as may happen for a number of days, 
he would advise the constant employment of decoct, cort. chinae 
(5.0-8.0:120) with aq. chlori (15.0) which may be changed for 
tincture of valerian if the pulse is sinking. Disinfection of the buccal, 
pharyngeal and nasal cavities, should be made by injection of these 



SCARLET FEVER. 301 

parts every two to three hours with a solution (two per cent.) of car- 
bolic acid, or with permanganate of potash (0.5:100). He has also 
had success in injecting the nose with sulphate of zinc (1.0:100.0) or 
brushing it with a five per cent, solution of chloride of zinc. In 
synovitis the painful or swollen joints should be wrapped in cotton. 
Lukewarm baths should be taken as soon as desquamation begins. 
Patients should not be allowed in the open air before the fourth week. 



This physician writes to the Deutsche Medizinal Zeitung, 16, 1882, 
that he has nearly always achieved a rapid cure in scarlatina-dropsy, 
and even when internal remedies could be no longer administered, by 
the following method: 

He daily rubs into the skin in the region of the kidneys a mixture 
of one part of croton oil, with two parts of ol. papaveris. Mostly 
one such innunction suffices to cause within a few hours the appearance 
of a severe eruption of the skin, and simultaneously a great improve- 
ment in the condition of the patient, and amelioration of all the dan- 
gerous symptoms. The change for the better at once sets in with the 
commencement of the artificial exanthem. If the symptoms again be- 
come aggravated, the procedure is repeated. Internally H. adminis- 
ters spirit, mindereri in small doses. 

DR. JOHN W. HAYWOOD, OF LONDON. 

This author describes {Lancet, 1883), two cases of malignant (hem- 
orrhagic) scarlatina that resisted all treatment and seemed doomed. 
The cuticle was removed from around the throat by a cantharides blister, 
and to the exposed cutis a wet compress sprinkled with crotalus was 
applied, and renewed, at first every half hour and then every three 
hours ; also a dose, dissolved in a teaspoonful of water, was dropped on 
the tongue every half hour. The symptoms all began to improve at 
once, and the author thus concludes : " The above notes of these two 
interesting cases were written at the time, and have been preserved and 
withheld from publication, in order to test the drug in similar cases be- 
fore publishing them. This has now been done over and over again, 
until the writer is thoroughly convinced that the above facts were no 
mere coincidences. 



302 DISEASES OF CHILDREN. 

DR. KEITH NORMAN MACDONALD, OF SCOTLAND. 

In the British Medical Journal (1883), Dr. Keith Norman 
Macdonald, after denying the prevalent opinion, that no reliance can 
be placed on any drug in cases of scarlatina, does not hesitate in affirm- 
ing that, when properly applied, both locally and internally, sulphurous 
acid is by far the most efficacious remedy we possess. He continues : 
" I have had several opportunities of testing its efficacy in some of the 
worst cases I have ever seen, during the epidemic which has been rife 
in this town (Cupar Fife) for the last two months, and I am bound to 
say that, of all remedial measures in this disease, it is, in my opinion, 
the most reliable. My treatment is as follows: The moment the throat 
begins to become affected, I administer to a child, say of about six 
years of age, ten minims of the sulphurous acid, with a small quantity 
of glycerine in water, every two hours, and I direct the sulphurous 
acid spray to be applied every three hours to the fauces for a few min- 
utes at a time, by using the pure acid in severe cases, or equal parts of 
the acid and water, according to the severity of the case. Sulphur 
should also be burned in the sick chamber half a dozen times a day, 
by placing flour of sulphur upon a red-hot cinder, and diffusing the 
sulphurous acid vapor through the room, until the atmosphere begins to 
become unpleasant to breathe. 

" In the worst cases, where medicine cannot be swallowed, this and 
the spray must be entirely relied upon ; and the dark shades which 
collect upon the teeth and lips should be frequently laved with a solu- 
tion of the liquor potass, permanganatis of the strength of about one 
drachm to six ounces of water, some of which should be swallowed, if 
possible. 

" In cases presenting a diphtheritic character, the tincture of perchlo- 
ride of iron should be administered in rather large doses in a separate 
mixture with chlorate of potash, and equal parts of the same with gly- 
cerine should be applied locally, with a camel's hair brush, several 
times in a day ; but, as in the majority of cases among children it is 
next to impossible to use a local application more than once, the spray 
and permanganate solution will then prove of great service. 

" As to other remedies recommended by various authors, ammonia is 
nasty, and connot be taken well by children ; carbolic acid has the same 
fault, and cannot be applied properly. Gargles are also useless in 
children, because they seldom reach the diseased surfaces, and warm 



SCARLET FEVER. 303 

baths and wet sheet packing are dangerous, because they are never 
carried out properly in private practice. The hypodermic injection of 
pilocarpine is a remedy that may give good results hereafter, but I 
have had no experience of its use." 

DR. JOHN W. AYLER, OF WEST VIRGINIA. 

This physician states in the Medical and Surgical Reporter, 1883, 
that he has had excellent results from a method of treatment that he fails 
to find reported in any text book. When called to a patient, he at once 
orders chlorate of potash and carbolic acid internally, with inunction of 
the whole surface of the body. The treatment is pushed throughout 
the whole course of the disease. 

DR. PAUL GERNE, OF FRANCE. 

This author says (Le Coyiconrs Medical, 1882,) that if you desire 
to use belladonna, the following is a good formula : 

345. R. Ext, belladonna, gr.ii| 

Distilled water, f. 3 viiss 

Alcohol, rectiiied, t^xv. M. 

Of this mixture, give as many drops, morning and evening, as there 
are years in the patient's age. 

In regular and normal forms of the disease the treatment should be 
purely hygienic ; the patient must be kept in bed, in a room having a 
temperature of from 64° to 08° F. 

The patient should not be surfeited with warm drinks ; he may have 
reasonable quantities of lemonade, to which wine can be added, when 
there are symptoms of weakness. 

Until the period of desquamation is reached, the food should consist 
of broth, unless otherwise speedily indicated. 

The infectious nature of the disease warrants the use, as recom- 
mended by Scott, of an aqueous solution of sulpho-phenate of soda, in 
doses of grs. viiss-xv. In irregular forms, the predominating symp- 
toms, will, of course, indicate the particular measures that should be 
adopted. The hyperthermia in those ataxic forms rapidly accompanied 
by serious nervous, comatose, convulsive, or dyspnoeic symptoms, is 
successfully checked by cold lotions and affusions, and in very severe 
cases, cold baths may even be given. 

As an anti-thermic remedy, we use sulphate of quinine ; but salicy- 



304 DISEASES OF CHILDREN. 

late of soda should never be displayed, because it might superinduce 
nephritis, which is always imminent, or aggravate it if already present. 

In syncopal forms, wine, alcohol, cinchona and digitalis, are to be 
exhibited. 

In gastrointestinal forms (complicated from the start by incoercible 
vomiting and profuse and persistent diarrhoea), opiates are to be used, 
also Seltzer water, and ice in small pieces be frequently given by the 
mouth. 

DR. LERVIS, OF FRANCE. 

Dr. Lervis {Le Progres Medical, 1882,) recommends digitalis to 
limit the acceleration of the pulse in scarlatina, and also as a prophylac- 
tic against renal complications. The infusion of digitalis should be given 
as soon as possible after the debut of the malady, and continued up to 
the third week. The whole body should be anointed with oil twice 
daily, until desquamation is completed. To prevent the development of 
diphtheritic angina, he recommends the following potion: 

346. R. Potass, chlorat., £j 

Tinct. ferri perchloridi, f. 3 ij 

Glycerinae, I5J 

Aquse clestil., f. 3 viij. M. 

S. — A teaspoonful every half hour. 

DR. JAMES Y. SHEARER, OF PENNSYLVANIA. 

This physician has had most excellent results from the cold treatment 
of this disease which he has practiced for twenty years. He sponges 
the whole body with cold water and applies ice to the throat, having a 
piece of muslin between the skin and the ice. He is careful to apply 
the ice to the inflamed cervical glands. 

DR. A. WORTHINGTON, OF CANADA. 

This author (Canada Lancet, 1881,) reports most satisfactory re- 
sults from the "Cold Water" treatment. His plan is to pour ice-cold 
water over the patient's head and neck for a couple of hours at a time, 
to sponge the entire body frequently, and to keep cloths wrung out of 
cold water constantly around the neck. He uses no medicine, except 
to keep the bowels open. He, of course, always meets with opposition 
from the parents, but he persists, and his reported success is very great. 



SCARLET FEVER. 305 

DR. LEICHTENSTERN. 

The means upon which this author relies (Archivio di Patologia 
Infantile, 1883), most extensively is the cold bath, administered from 
the time that the exanthema is well developed. He usually immerses 
the child for from ten to fifteen minutes. The contra-indications for 
its use are: 

1. Cardiac collapse or a tendency thereto, with a cold and cyanotic 
skin. 

2. Laryngeal stenosis, when diphtheria complicates the disease. 

3. Inflammatory swelling and infiltration of the cellular tissue of the 
neck, with venous obstruction. 

4. Possible impending pharyngeal or nasal hemorrhages from diph- 
theritic erosion of the large vessels ; absolute quiet being imperative. 

6. The severe form of poly-articular synovitis and scarlatinous ten- 
denitis, in which the slightest movements are painful. Less reliable, 
in the author's hands as an antipyretic, is quinine, which is not without 
danger in children from the possibility of quinine collapse. 

If given at all, it should be in small and rather frequent doses. Of 
salicylic acid he speaks with more confidence as an antipyretic. He 
usually gives it in the form of the soda salt, in seven grain doses, at 
intervals of half an hour, until the fever is controlled. In some cases 
it was effective when the cold bath failed. He thinks its supposed un- 
favorable effect upon the heart is imaginary. For alimentation he pre- 
scribes milk, eggs, gelatine and nutritious soups. Stimulation is often 
necessary, and lor this purpose red wine, cognac or champagne may be 
given. Massage and counter-irritation, in the form of blisters, are also 
beneficial at times. 

DR. WILLIAM B. ATKINSON, OF PHILADELPHIA. 

According to this teacher {Medical and Surgical Reporter 1880), 
in every case of this disease, whether mild or malignant, much depends 
upon the care and attention of those who are to act as nurses. The 
efforts of the physician must be directed to the relief of urgent symp- 
toms, as intense febrile action, the prevention of debility, and of com- 
plications. 

The patient should be kept in bed in a well-ventilated room, with 
especial care to avoid the slightest exposure to a draught. In ordinary 
cases the medicinal treatment will be limited to the meeting of indica- 
20 



806 DISEASES OF CHILDREN. 

tions as they arise ; the patient should be allowed cool, acidulated 
drinks, and plain, easily digested food. Sponging the whole surface 
with tepid wated is in many cases very comforting. The same effect is 
produced by the process of inunction. The usual domestic remedy is 
pure lard, or the fat of bacon. Preferable is the unguentum petrolei 
or "cosmoline," and where the itching is very annoying, it is better to 
employ the carbolated preparation, which contains three per cent, of 
carbolic acid. The inunction should be repeated at intervals, as cir- 
cumstances demand, to relieve the dryness and mitigate the great heat 
of the skin. 

The physician must constantly keep in view the tendency to depres- 
sion, and remember that stimulants are to be employed at the earliest 
indication of debility. Preparations containing chlorine in some lorm 
have long been favorites with the profession, under the belief that this 
article acts to destroy the poison of the disease. Watson, in his 
Principles and Practice of Physic, gives this formula : " Put eight 
grains of the chlorate of potassa into a pint bottle, and pour upon them 
one drachm of strong hydrochloric acid. Keep the mouth of the bot- 
tle closed until the violent action has ceased ; then add an ounce of 
water, and shake the mixture well ; then add another ounce of water, 
and again agitate well; and so on, until the bottle is full. The chlor- 
ate should be pulverized, and in cold weather the bottle should first be 
warmed. A tablespoonful or two of this mixture, according to the age 
of the patient, may be given for a dose, frequently. An adult may 
take the whole pint in a day." 

At present, many practitioners employ a formula containing the 
chlorate of potassa and the tincture of chloride of iron, regarding this 
combination as of great value, also, to meet the throat symptoms. 
When needed, the throat may also be gargled with this combination in 
honey and water. For the great restlessness the bromide of potassium, 
or of sodium, will be found valuable in moderate doses, repeated at in- 
tervals of an hour or two, until quiet is produced. 

Many authorities agree that in consideration of the poisoned condi- 
tion of the blood, small doses of carbonate of ammonia should be given 
every two or three hours. 

J. Lewis Smith gives the following : 

347. R. Amnion, carb., 

Ferri et amnion, citrat., aa ges 

Syrup, simplic, i-^iv. M 

One or two tablespoon fu Is every two or three hours. 



SCARLET FEVER. 307 

Some prefer the liquor ammoniae acetatis, and this, in all cases, 
should be employed with an excess of the ammonia. 

Should the sypmtoms indicate exhaustion, with the decline of the 
eruption, quinine should be employed, as also the carbonate of am- 
monia. 

In his own experience, no single remedy has given such good and 
such constant results as digitalis. About the year 1858 the late Dr. 
Lewis P. Gebhard read a paper before one of our medical societies, 
very strongly advocating the use of this article in all the forms of this 
disease, and claiming for it the character of a specific. His method 
was to put one drachm of the powdered leaves of digitalis to twelve 
tablespoonfuls of boiling water, and when the infusion had cooled, to 
give it in teaspoonful doses every hour or two, according to the age of 
the child and the gravity of the symptoms. Since that time Dr. 
Atkinson has used it in a large number of cases and with the best re- 
sults. He generally orders it prepared in the same way, and directs 
the nurse to give it in teaspoonful doses every hour or two, until the 
pulse and temperature are positively reduced ; then to lengthen the in- 
terval, so as to maintain the effect thus obtained. He believes that he 
has almost invariably observed the symptoms to moderate within from 
twelve to twenty-four hours, and he feels confident that while he has 
never in a single instance known any of the so-called 'poisonous effects 
of the remedy to follow, he has also failed to see the usual dangerous 
sequela in many cases, and only slightly in any. He has never seen 
anything to warrant a belief in its usually dreaded " cumulative effect.'' 1 

DR. W. VAWDREY LUSH, OF ENGLAND. 

After ten years' experience, added to fifteen of Dr. Thompson's, this 
author speaks highly, in the Lancet, 1880, of the warm bath treatment 
of scarlatina. At first, he orders the patient to have three warm baths 
daily, to be kept in from three to five minutes, rapidly dried, wrapped 
in a blanket, and returned to bed. As the disease subsides, he reduces 
the baths to two or only one daily. He finds that it brings out the 
rash, reduces the temperature and soothes the patient. 

DR. J. MURPHY/, OF ILLINOIS. 

Dr. J. Murphy states, in the Peoria Medical Monthly, 1880, that 
he has found the following formula of great benefit in the treatment of 
scarlet fever : 



808 DISEASES OF CHILDREN. 

348. R. Acid, salicylis. gij 

Mucilag. acaciae, 

Aqr.se rosge, aa ^ iss 
Syr. tolu, |j. M. 

Of this mixture one or two teaspoonfuls, according to the age of the 
child, should be given every two hours until a favorable impression has 
been made on the throat and on the general symptoms. When this has 
been accomplished the intervals of administering the medicine should 
be extended to four or five hours, varying the periods as the changing 
symptoms of the disease may indicate the propriety or necessity of. 
During the existence of the acute symptoms, the use of the acid should 
not be permitted to interfere with the sustaining treatment, which is so 
essential in this disease. Nor should its continued use after the acute 
symptoms have subsided prevent the adoption of the tonic treatment so 
positively required during the period of convalescence. 

M. ARCIIAMBAULT, OF PARIS. 

In the Medical Press and Circular, 1880, this great teacher says 
that there is a certain class of infantile diseases for which it is not at all 
necessary that the physician should display his skill. Scarlatina is one 
of these. Put the patient to bed in a well-ventilated chamber, but the 
windows should not be opened. The temperature of the chamber 
should not exceed 64°. When the fever falls the temperature may be 
raised a little, because the patients have tendency to chills. The cover- 
ing should be no heavier than in health. How long would you leave a 
patient in bed? Some say that he might get up as soon as the fever 
fell ; others, on the contrary, exact a month or six weeks. Leave him 
a long while in bed, about three weeks. The statistics of an English 
doctor, comprising six or seven hundred cases of scarlatina, show that 
nephritis appeared oftenest from the fourteenth to the eighteeth or 
twenty -second day. If, then, nephritis is due to cold, it will be well to 
oblige the patients to keep their beds. They might sit up in bed, but 
care should be taken to put a kerchief around the neck, for secondary 
sore throats are grave. It would be well also to recommend mittens on 
the wrists, the carpal articulations being the most subject to the rheu- 
matism which is frequent after this disease. The patients should not 
go out before the thirty-fifth or fortieth day; but that will depend 
again on the gravity of the disease. Bartiiez has said that he did not 
know of any case of anasarca after scarlatina since he forced his 



SCARLET FEVER. 309 

patients to keep their bed during five or six weeks. Hot drinks should 
not be given unless the eruption does not come out properly. Refresh- 
ing drinks, such as lemonade, gooseberry wine, etc., are preferable. 
To aid the eruption he has given the acetate of ammonia. If the 
patient is constipated, a little rhubarb or castor oil will suffice. If the 
nights are restless, a little bromide of potassium is of great benefit. 
The mouth must be washed often, but for the throat, caustics are seldom 
necessary. Chlorate of potash, or alum gargles will be sufficient. If 
the patient is too young to gargle, one or two grams of chlorate of 
potash mixed with five or six grams of white powdered sugar may be 
given. One might order a bath if the fever were very high and the 
eruption abundant, but in ordinary cases it would be better to dispense 
with it. This practice is much used in England ; it is thought hazard- 
ous in France. Sometimes the itching is very great. Some German 
doctors conceived the idea of rubbing the children with fresh lard, but 
to this procedure, which is not very clean, he prefers the English 
method, which is a mixture of glycerine and cold cream. As regards 
nourishment, it is evident when the fever is high a light diet should be 
prescribed ; when the fever abates, a stronger nourishment might be 
administered, but with caution. 

Such is the treatment that will suffice in scarlatina ; it is simple, and 
will not cover you with glory, but it will cure your patients, and will 
prevent, in the majority of cases, complications. Do not neglect, above 
all, hygienic precautions, for there is not a case of scarlatina that ought 
to be neglected. 



This author enunciated his views before the last meeting of the 
American Medical Association, which may be thus summarized. 

There are two safe and efficient means always at hand to control high 
temperature. One is the warm bath, either by the immersion of the 
body in water at a temperature of 80°, or the wet pack at the same 
degree, repeated every three or four hours until copious perspiration 
follows. 

The patient is permitted to repose in the wet sheet, enveloped in 
blankets, the entire body being for hours subjected to free perspiration, 
and of course undergoing the combined antipyretic and eliminative pro- 
cesses. In connection with those measures the sedative treatment is 



310 DISEASES OE CHILDREN. 

also practiced. For this purpose I have found the following formula 
well adopted: 

349. R. Infns. digitalis, f-^U 

Tinct. aneonit. rad., gtt. xvj 

Spts. amnion, arom., f. ^iij 

Spts. nit. eth., f. gj. M. 

S. — A teaspoon ful in water every two hours to a child of rive years. 

This method of treatment in my experience rarely fails to induce a 
marked change for the better in the temperature and pulse. 

In this manner we accomplish two leading objects simultaneously. 
My rule has been, in those cases attended with excessive inflammation 
and swelling of the structures of the throat and neck, a very high 
grade of temperature, and frequent pulse, to reduce the pulse rate and 
temperature by the combined agency of digitalis and aconite, as rapidly 
and steadily as is consistent with safety, down to a standard perfectly 
compatible with life. This peculiar combination I regard as particu- 
larly effective in this class of cases, and whatever dangerous or ill effect 
the one may exert is counteracted by the other. 

In this way many cases of the severe form of what is termed the 
anginose variety with decided malignant tendencies may be robbed in 
great measure of malignancy of type, and converted into more simple 
and manageable forms. With a slow, strong pulse, and a moderately 
low temperature, the chances for life become at once greatly improved. 
The combined influence of the sedative and eliminative treatment over 
the extensive and dangerous swelling of the structures of the throat, 
usually diminishes the effusion and inflammation permanently, and in 
proportion to the abatement of fever. Long and continued experience 
in the use of eliminative measures through the skin and kidneys, prin- 
cipally the former, only tends to increase my high estimation of the 
great value of this means of treatment in all the more severe forms of 
scarlatina. 

In all grave forms of the affection the skin is particularly dry, and 
devoid of perspiration. My custom has been, in all of this class of 
cases, to maintain a free and continuous action of the skin by means of 
the tepid bath and the wet pack, throughout the course of the attack. 

For the purpose of illustrating what may be accomplished in the con- 
version of a very grave and malignant type of this disease into a very 
simple and benign form, I will cite the following case: '• A little boy of 
six years, in very robust health, in 24 hours after the first indications 



SCARLET FEVER. 311 

of scarlatina, became alarmingly ill with malignant symptoms. The 
eruption was imperfect in development ; the pulse so frequent that it 
could not be estimated. There was great stupor. The temperature 
ranged at about 106° ; the general prostration was correspondingly 
great. The child was first given a general bath at 80°, then envel- 
oped in a wet sheet at the same temperature, and over this a dry 
blanket; then put to bed and permitted to luxuriate in a free and de- 
lightful perspiration for many hours. When the temperature increased, 
the same process was resumed. Then he was given a drachm of infu- 
sion of digitalis, one drop of the tincture of aconite root and ten drops 
of sweet spirits of nitre, every two hours, until the pulse and tempera- 
ture were reduced to near the normal standard. Then the conscious- 
ness and vital powers of the little patient returned, and the type of the 
ca?e in another 24. hours was changed from a very dangerous to a very 
simple one. 

Treatment of the Trve Adynamic Type of Scarlatina. We occa- 
sionally meet with a class of cases presenting, from the incipiency, 
symptoms of adynamia. The eruption is always of a dark or mahogany 
color, and not abundant; the pulse is exceedingly frequent and feeble. 
The urine is dark, very scanty, and often albuminous. There is exces- 
sive stupor and prostration of the vital powers, the tongue a dark red 
and very dry. We all appreciate the gravity of these cases. The 
treatment which I have found most efficient in this type of disease, 
consists of the wet pack saturated in water at 80°, with a considerable 
proportion of alcohol combined, used sufficiently often to maintain a 
moderate perspiration. The following formula I have found the most 
useful of all of which I have made trial : 

350. R. Sodse sulph. carbolat., giss 

Sod 03 hyposulphite, jj j 

Aqua, %iss 

In fus. digitalis, Jfiss 

Tiiict. mix vom., gtts. xij. 

Of this two teaspoonfuls are to be given to a child of five years 
every two hours. Alternately with this, a teaspoonful of brandy and 
elix. of calisaya are to be administered. 

In these cases the temperature rarely reaches a very high grade. 
The temperature and circulation are both unequally distributed. The 
extremities are usually cool and livid, the body hot. The action of the 



312 DISEASES OF CHILDREN. 

heart is excessively feeble and frequent, often reaching a rate of 200 
per minute in very young children. The poisoned condition of the 
blood renders the dangers of thrombosis of the heart, lungs and brain 
imminent. This condition is particularly encouraged because of the 
inability of the heart to maintain an equable circulation. Hence in these 
cases we need especially a remedy which will both slow and strengthen 
the action of the organ. 

The Treatment of the Malignant Type Due to Early Renal Com- 
plications. — In a certain proportion of cases the malignancy of type 
seems to be due to early renal complications. We observe in these 
cases the early development of malignant features very similar to those 
manifested in cases of serious nephritis from more simple causes. Thus 
there is always tendency to coma. The urine is very scanty, high 
colored, acid in reaction, and albuminous. The temperature is high, 
and the pulse-rate very frequent. There may be but moderate adenitis, 
yet the case presents all the indications of gravity and danger. 

In all cases of importance I believe it to be our duty to examine the 
state of the urine throughout the course daily. 

Doubtless many cases have assumed the malignant type and ended 
fatally, solely because of the development of nephritis. In the treat- 
ment of these cases all of our appliances, consisting of the warm bath, 
the wet pack, and if necessary, the hot air bath, for the purpose of 
inducing copious elimination through the skin should be brought to bear 
on the patient frequently. 

Prolonged observation of scarlatina convinces me that our attention 
is directed usually to renal complication at too late a period of the case, 
and that treatment is often delayed too long. In cases of nephritic 
complication, with high grade of fever and frequent pulse, I have found 
a combination of alkaline diuretics with sedatives of infinite service. 
The alkaline diuretics can not only be given freely in these cases with- 
out harm, but with benefit. In my experience it is best to maintain 
the urine in a perfectly neutral and bland state, so that its acids can- 
not act as irritants and thereby aggravate the existing inflammation. I 
have found the following formula a valuable one under these circum- 
stances : 

351. R. Liq. potass, citratis, f. £iss 

Potass, bicarb., Z \ \ 

Spts. nit. ether, % iij 

Tinct. aconit. rad., gtt. xij 

Infus. digitalis, f. £ j. M. 

A dessertspoonful every 2 or 3 hours to a child of 5 years. 



SCARLET FEVER. 313 

This combination of therapeutic agents usually exerts a most favor- 
able influence over the engorged and inflamed kidneys. Their func- 
tions are always improved and generally restored. At the same time 
the action of the heart is slowed and strengthened ; the abnormal tem- 
perature is reduced to a point of safety and the nervous centres re- 
lieved. 

In connection with this method the patient is fed liberally on skimmed 
milk. 

I do not remember to have seen a case of organic renal disease or 
dropsy following scarlatina in an exclusively nursing infant. Whether 
this is due to the exclusive milk diet, to the exclusion of animal food, 
or to the better care or protection from cold, is not known. 

The Treatment of Protracted Adenitis, followed by Abscesses and 
Symptoms of Pyaemia, — In the severe anginose form of the disease, 
protracted adenitis, followed by a long line of abscesses in diiferent 
portions of the system and symptoms of pyaemia, occasionally occurs. 
The fever is usually hectic in character. The temperature rises and 
remits at certain periods of i^he day, followed occasionally, but not 
always, by exhausting perspirations. The tongue is usually red and 
dry. There is complete anorexia ; symptoms of adynamia are always 
present. The process of emaciation is progressive. These morbid 
processes may continue in operation for many weeks, and either end in 
death or restoration. 

I have found in this particular affection no combination of remedies 
so effective as the tinct. of the chloride of iron, arsenic and digitalis. 
I usually give to a child of five years, five drops of the iron, one-third 
of a drop of Fowler's solution of arsenic and three drops of the tinct. 
of digitalis every four hours. This method of therapeusis should be 
maintained until the pysemic tendency has been arrested. In this place 
I regard the arsenic as an important ingredient. 

When the tendency to exhausting perspiration is decided, I usually 
combine the tinct. of belladonna. 

Treatment of the Convulsions of Malignant Scarlatina. — A his- 
tory of the treatment of scarlatina would be very incomplete without 
allusion to the subject of convulsions. Usually in these cases renal 
complications are present, and must receive a share of our treatment. 
The pulse in these cases is usually very frequent and the temperature 
high. The entire voluntary, reflex, and ganglionic nervous centres are 



ol4 DISEASES OF CHILDREN. 

all profoundly affected by the infectious poison. To relieve the circu- 
lation of uraemic poisoning,, which is generally present, and to prevent 
that irreparable damage to the brain which results from the capillary 
thrombosis and extravasation of blood that may arise from the violent 
and unequal action of the heart, our remedial agents should be ad- 
dressed to the eliminative organs, the reflex nervous system, and the 
general circulation. Elimination through the skin and kidneys, as 
heretofore advised, should be assiduously practised. Chloral hydrate, 
to control the over-excited reflex centres, and veratrum viride combined, 
have been more efficient in my experience as a means of reducing 
cardiac action and regulating the unbalanced circulation, than any other 
agents. Five grains of the chloral and one or two drops of the tinct. 
veratrum act well after the functions of the skin have been restored. 
These remedies should be repeated every two hours to a child of five 
or six years until the object has been attained. In dangerous cases of 
this kind I regard the use of the veratrum as an important addition to 
the treatment. In my own hands, when combined with chloral, it has 
been more prompt, energetic, and decided in repressing the convulsive 
tendency than any other therapeutic agent. 

Treatment of Scarlatinous Pharyngitis. — After a trial of the 
various local remedies devised by myself and recommended by others, 
I have reached the conclusion that a combination of. astringent and an- 
tiseptic agents, composed of bromo-chloralum §j, the antiseptic vegeta- 
ble compound known as hsterine 5ij? pulverized alum 5ij> carbolic acid 
gtt. x, diluted with rose water giv, either used by means of gargling, 
the atomizer, or brush to the inflamed surface, constitutes the most 
valuable of all the local applications. I feel sure that the absorption 
of the antiseptic properties through the mucous surface is in such quan- 
tities as to exert decided effect. Two or three drops of carbolic acid, 
when applied to the cervix of the uterus, will be tasted by the patient 
almost instantaneously. 

I have faith, also, in the value of antiseptic agents applied to the 
cutaneous surface. When carbolic acid, salicylic acid and ointment of 
rose water in combination are applied to the skin, they act not only as 
an emollient, allaying inflammation and irritation, but the antiseptic 
agents being spread over a vast extent of surface, are largely absorbed, 
and exert their peculiar influence in correcting the septic processes 
going on within the system, thus saving the digestive organs the ill 
effects of their influence. 



SCAKLET FEVER. 315 

In the selection of nourishment, we should be influenced both by the 
condition of the digestive organs and the renal functions. In cases of 
seriously impaired digestion, irritable stomach, scanty, albuminous and 
acid urine, the best method of administering nourishment, in my ex- 
perience, is in the form of skimmed milk, containing a small amount of 
bicarbonate of soda in solution, and combined with one-third lithia 
water. This may be continued so long as these symptoms exist. 

In all serious cases preference is given to the alkaline lithiated milk 
as a constant diet. The milk is evidently better digested and assimi- 
lated than any other form of nourishment. It is in this form exceed- 
ingly bland and unirritating to the renal passages, and affords relief to 
the engorged and inflamed kidneys. It is given abundantly, and almost 
exclusively. This form of diet not only serves a good purpose during 
the acute stages of the disease, but acts well as a prevention of renal 
sequelae. 

NOTES ON REMEDIES. 

Aconite. Baetholow tells ns that there are two conditions of this disease, 
especially requiring the use of aconite — the eruptive stage, and the 
period of desquamation, if, as is usual, a marked rise of temperature 
takes place at this period of the disease. Several important purposes 
are subserved by the use of this remedy ; it lowers the fever heat, 
favors the action of the skin and kidneys, and checks the nasal, faucial 
and aural inflammations, which constitute such troublesome complica- 
tions and sequelae. 

AlcoJwl. Dr. Giles Mitchell reported to the Cincinnati Academy of Medi- 
cine, (1883,) forty- three consecutive cases of scarlatina, treated with 
large doses of alcohol, without a single death. A half ounce of 
whisky every hour was given to a child two years old, without the 
slightest symptom of intoxication. When the kidneys became impli- 
cated, the alcohol was still used. It always produced a fall of temper- 
ature. Dr. John M. Keating, of Philadelphia, endorses this treat- 
ment. 

Ammonii Spiritus Aromaticus~h&s recently been recommended in the following 
form by Dr. Sweeting : 

352. R. Spiritus ammonias aromatici, f-^iij 

Sodii et potassii tartratis, 5J 

Tinct. lavandulae comp., f. % j 

Aquam, adf. ^iss. M. 
A teaspoonfal every third hour for a child five years old. With this 

he orders as a diet undiluted sweetened milk, and uses no external 
treatment whatever. 

Ammonii Carbonas is highly esteemed by many authorities. Mr. G. J. S. 
Camden, (Medical Times and Gazette, February 1, 1873,) gives it at 






316 DISEASES OF CHILDREN. 

the very onset of the disease, in distilled or cold boiled rain-water 
filtered. He never gives emetics or aperients, nor bleeds, nor does 
anything to lower the vital powers. Mr. Erasmus Wilson {Diseases 
of the Skin) confesses to a strong leaning in favor of ammonia treat- 
ment, and, instead of salines, begins, from the first, with a solution of 
the carbonate of ammonia ; 2 or 3 grains for a child under seven years 
of age, and 4 or 5 grains for a child above this age, dissolved in from 2 
to 4 drachms of water, and administered every one, two, three, or four 
hours, according to the degree of severity of the fever. (See, also, F. 
347.) 

Argenti Nitras. Dr. Edward Copeman remarks, in the St. George's Hospital 
Reports, 1870, that for the relief of those severe cases in which there is 
a profuse ichorous discharge from the throat and nostrils, with disposi- 
tion to sloughing ulcers in the pharynx, he has seen no local remedy so 
successful as a free application of a solution of nitrate of silver (from 
4 to 8 grains to an ounce), by means of a brush or syringe. Dr. Nie- 
meyer also recommends the nitrate. He says that, in anginose cases, 
as soon as the sloughs have been detached, we may touch the ulcers in 
the throat daily, with a solution of nitrate of silver (gj co £ij water), 
applied by means of a probang ; and for the coryza, we may inject a 
weak solution of nitrate of silver (gr. v-x to 3 ij water) into the nos- 
trils. Croup complicating angina maligna indicates the administration 
of an emetic and the application of a solution of nitrate of silver to the 
glottis. 

Baptisia Tinctoria. The electic physicians assert that a gargle prepared from 
the wild indigo weed, acts specifically in the sore throat of scarlet fever. 
(Scudder.) 

Belladonna is said by Bartholow to be useful when the eruption is imperfect 
or bluish, the peripheral circulation feeble and the heart's action de- 
pressed. It is also highly recommended by Dr. Henry Beates, Jr., 
of Philadelphia, in the Medical and Surgical Reporter, 1883, and Dr. 
Owen Pritchard {Lancet, 1881,) thinks that when given to those who 
are exposed to the disease it will act as a prophylactic. 

Brominium. Dr. W. H. Thompson, (New York,) has met with far fewer throat 
complications since he has used this agent. He employs it as follows : 

353. R. Potassii bromidi, q. s. ad saturandum 

Aquae, f . J ij 

To this, add very slowly, and with frequent shaking : 

Brominii, f. ,^j 

Aquam, adf.giv. 

Of this solution, 1 drachm is added to 1 ounce of water, and a tea- 
spoonful is given in a tablespoon ful of sweetened water, as required, 
the solution being kept in a dark place. As a local application, equal 
parts of the solution and of glycerine are used, or, in bad cases, the 
solution alone. Occasional purges of calomel- and jalap may be given, 
until the action of which the antiseptic may be suspended. 



SCARLET FEVER. 317 

Carbolicum Acidum, gr. j-ij to aquae f.gj, has been used as a gargle for the sore 

throat. (See F. 336, 337.) 
Chlorini Aqua is very highly praised by nearly all writers. One formula for the 

chlorine mixture is given above. Another is : 

354. R • Potassii chloratis, gr. lxxx 

Acidi muriatic diliiti, f. 3^J 

Aquae, Oij. M. 

This amount to be taken in small doses, in the twenty-four hours. 

Mr. Erasmus Wilson's formula is : 

355. R. Potassii chloratis, 3J 

Acidi nitrici diluti, f. 7, j 

Aquae, f.gviij. M. 

For a gargle. 

Copaiba. Mr. A. Rowand {Medical Times and Gazette, February 17, 1871.) gives 
balsam of copaiba in 4- or 5-drop doses, mixed in 3 ij syrup, and 3ij 
mucilage of gum arabic, three or four times a day, with most satisfac- 
tory results. Under its use, the tongue and sore throat get rapidly 
clean and well, and the usual sequelae do not appear. 

Digitalis. Prof. Bartholow declares that, in a considerable experience in the 
treatment of scarlatina, he has found digitalis uniformly successful, 
and, taking in a gioup the ordinary cases of scarlat.na simplex and 
scarlatina anginosa, it is the most efficient remedy we possess. The 
particular effect of digitalis, in preventing nephritis and other glandu- 
lar inflammations, has been mentioned in the Lancet, January 23, 1869, 
by Dr. Sydney Fennel. He has used it largely in scarlatina, and 
says that, when administerd early in the fever, the inflammatory action 
in the glands of the neck subsides gradually. The fever leaves the 
patient in the usual time, desquamation is very slight, and the chances 
of chronic nephritis are reduced to a minimum. He also confidently 
asserts that the infectious character of the disease is lessened by the 
remedy, if not destroyed. 

Ferrum. Dr. R. Aldridge (British Medical Journal, August, 1871,) speaks 
favorably of the use of iron in scarlatina. He has found if it be given 
as soon as the disease makes its appearance, that not only does it 
shorten and lessen the severity of the attack, but it also fortifies the 
patient against the after consequences — dropsy, etc. The form which 
he has mostly used has been the liquor of pernitrate of iron, in syrup 
of glycerine, in doses of 10 minims every three hours. 

Hydrogen Peroxide. This substance has been warmly urged in scarlatina, by 
Dr. John Day, of Australia. His formula is : 

356. R. Hydrogen peroxide (ozonic ether), giv 

Pure lard, ^iv 

Benzoic acid, ^j 

Otto of roses, gtt. iv. M. 

To be carefully mixed without the aid of heat. 



318 DISEASES OF CHILDREN. 

With this the body of each patient is rubbed, over the whole surface, 
three times a day. He also prescribes, throughout the whole course of 
the disease, a mixture composed of 2 or 3 drachms of ozonic ether in ± 
pint of water ; the dose ranging from a teaspoouful for a child twelve 
months old, to a tablespoonful for an adult, to be taken every second 
hour. This is used for the double purpose of benefiting the throat 
symptoms and disinfecting the breath. 

Pilocarpine in doses of z \ of a grain, hypodermically administered, is highly 
recommended by Dr. Frank Shearer, of Edinburgh. (Glasgow Med. 
Jour., 1884.) 

Potassii Chloras, is perhaps the most widely used of all drugs in scarlet fever. 
(F. 346.) Large doses may be given to the youngest infants, especi- 
ally in the adynamic type of the fever. It has been amply shown by 
Dr. Drysdale, of Philadelphia, that this salt can and ought to be given 
far more freely that is usually done. 

Quinim Sulphas. In malignant cases some have advocated large doses of quinine 
to obtain decided antipyretic effects. The reside of this measure is 
questionable. 

Salicylicum Acidum has been experimented with by Dr. David J. Brackenridge, 
of Edinburgh, (Medical Times and Gazette, December, 1876,) but his 
results were not satisfactory. Dr. Powjnall, on the other hand, {Brit. 
Med. Jour., Dec. 21st, 1878,) claims that it is one of the most reliable 
remtdies. lie uses : 

357. R. Acidi salicylici, 3.HJ 

JSyrupi simplieis, 5 iv 

Muoilag". tragaeanth., 3 j 

Tinct. aurantii, 3 iv 

Aquam, ad. 3 vj. M. 

A tablespoonful every second hour. 

Sodii Bcnzoatis is highly recommended by Dr. Demme {Allgemiene Wiener 
Medizirtitiche, Zeituiig, 1880.) Internally he gives from live to twenty 
grams daily, dissolved in from one hundred to one hundred and twenty- 
five grams of water, with the addition of from one to one and a half 
grams of liquorice juice. 

Sodii Sulpho-carbolas. This has been administered by Dr. Brackenridge in 
closes of gr. v-xxx three or four times a day, and he asserts that it has 
proved very beneficial. American experience is against it. Dr. 0. S. 
Earle, of Chicago, says that not only has it failed to mitigate a single 
symptom, after the development of the disease, or to diminish the sus- 
ceptibility of those liable to contract it, but it has seemed to diminish 
the vis medicatrix naturie, to lessen absolutely the chances of recovery, 
by its impoverishinentof the system. {Trans, of the Illinois State Med- 
ical Society, 1878.) 

Sulphur. The use of this old remedy has been very highly lauded of late. Mr. 
Henry Pigeon writes to the Lancet, Nov. 25th, 1876, in these words: 
"The marvellous success which has attended my treatment of scarlet 



SCARLET FEVEH. 319 

fever by sulphur, induces me to let my medical brethren know of my 
plan, so that they may be able to apply the same remedy without de- 
lay. All the cases in which I used it were very well marked, and the 
epidermis on the arms in each case came away like the skin of a snake. 
The following was the exact treatment followed in each case : Thor- 
oughly anoint the patient twice daily with sulphur ointment ; give 5 to 
10 grains of sulphur in a little jam three times a day. Sufficient sul- 
phur was burned twice daily (on coals on a shovel) to fill the room with 
the fumes, and of course was thoroughly inhaled by the patient. Under 
this mode of treatment, each case improved immediately, and none 
were over eight days in making a complete recovery, and I firmly 
believe in each it was prevented from spreading by the treatment 
adopted." Dr. F. L. Sim, of Tennessee, {Medical and Surgical he- 
porter, Dec, 1877,) has had remarkable success by thoroughly fumi- 
gating the child under a blanket, with the fumes of burning sulphur. 
Veratrum Viride has been employed to reduce the pyrexia. 

EXTERNAL MEASURES. 

Baths, of all temperatures, are used. Dr. Hiram Corson is earnest in favor of 
the cold bath. (P. 296.) Dr. Eddison, and others, prefer baths com- 
mencing at 9G°-10t° cooled down slowly or rapidly to 70°. Dagger 
from "driving in the rash" is asserted to be imaginary. Dr. G. 
Johnson prefers the waim bath-only. Tepid and cold sponging will 
often be found sufficient. In adynamic cases, with low pulse, pallid 
skin, and cerebial symptoms threatening, a hot mustard-bath will often 
have the best effect ; or the child may be strippeel and wrapped in a 
sheet well wrung out with mustard water, and then packed in between 
two blankets. When the temperature reaches 104°, the cold wet pack 
may be used, and is never followed by any harm. Wring fiom a wet 
sheet the water at the oiclinaiy teinpeiatuie, wrap the chilel in it, and 
over that lay one wiung out of iced water. The prompt manner in 
which the symptoms improve shows the wet pack to be one of the great 
therapeutic resources in this class of cases. 

Inunction with olive oil, fresh butter, bacon rind, cocoa butter, w 7 aim benzoated 
lard, and such pieparations, repeated three or four times a day, should 
be employtd. The value of this is that it is the most effectual means of 
relieving the itching ol the skin and the excessive restlessness which is 
due to the irritation of the peiipheral nerves, caused by the heat of the 
skin. This is lelieved moie rapidly by oiling than by sponging with 
tepid water. Oiling, too, is truly antipyretic, reducing the temperature. 
Another reason for its use is found in the close sympathy found existing 
between the tkin and the kidneys. It is also lecommencled for its pro- 
phylactic properties. (See p. 295.) Dr. L. C. Johnson (Cinn. Lancet 
and CUnic, Sept., 1879,) prefers the following ointment: 

358. B . Glycerinse, gij 

Acidi carbolici, gr. viij 

Olei rosae, gtt. ij. M. 

Anoint with the palm of the hand after the patient has been bathed 
and diied. 



320 DISEASES OF CHILDREN. 

SCLEREMA NEONATORUM. 

DR. EDWARD HENOCH, OF BERLIN. 

The characteristic feature of this affection is the hardness and rigidity 
presented to the pressure of the finger by the integument of a large 
part of the body. In the most extreme forms the body feels as hard as 
if frozen, though not uniformly in all places. It is accompanied by 
greater or less diminution in temperature. The aifected children are 
feeble, prematurely born, emaciated, and all of them die. Cases of 
sclerema are incurable ; the patients die in extreme collapse, but some- 
times not until the lapse of two or three weeks. The treatment must be 
confined to dietetic and hygienic measures. Obtaining a good wet 
nurse is a main indication (if the child cannot nurse, it must be fed 
with mother's milk drawn from the breast, or with good cow's milk), 
combined with means for artificial warmth (frictions with warm flannels, 
warming pans, aromatic baths). Internally we may use small doses of 
wine. 



SCROFULA. 



DR. EDWARD HENOCH, OF BERLIN. 

Among the drugs that are usually termed " anti-scrofulous," this 
author prefers iodine, given in combination with iron, as syrup ferri 
iodidi (5-12 drops three times a day) or with iodide of potassium. 
If no disturbances of digestion are produced, the remedy must be con- 
tinued for months, but is contraindicated by the presence or suspicion 
of pulmonary tuberculosis. He has never observed symptoms of so- 
called iodism, such as are sometimes described ; at the most, there may 
be severe coryza or erythema in the face or other parts of the body. 
When circumstances prevent the use of natural mineral baths, we can 
give salt baths at home, putting from one to five pounds of common salt in 
the bath. It seems doubtful to our author whether the traces of iodine 
contained in cod-liver oil possess any specific effect. This much-lauded 
remedy probably acts rather as an article of nutrition, in the same 
manner as fatty articles of diet in general, and it is therefore said by 
some that it may be entirely replaced by olive oil. In his experience 



SCROFULA. 321 

it is far inferior to iodine, and he warns against too large doses, as it 
readily interferes with digestion. Two or three tablespoonfuls daily are 
amply sufficient. The inunction of cod-liver oil on the skin, so highly 
recommended by many authors, he considers objectionable on account of 
the disagreeable odor and uncleanliness. Nor does he observe any 
good effects from other lauded remedies, such as Plummer's powders, 
walnut leaves, etc., and he considers that we only lose time by trifling 
with these remedies. In addition to this general plan of treatment, the 
various local affections, such as inflammation of the eye, diseases of the 
bones, joints, skin and mucous membranes, present a number of indica- 
tions for special treatment. 

DR. FORSTER, OF GERMANY. 

According to this writer in Jahrbuch fur Kinder heilkunde, Band. 
xxi., Heft 3, scrofulosis is exceedingly common in children, and evi- 
dences of it are found in more than half the children dying within the 
first six months whose bodies are examined. The two objects of pro- 
phylaxis are, firstly, to combat the disposition to disease ; and secondly 
to ward off infection. The first indication is fulfilled by providing 
good food, warm clothing, fresh air, a country life and sea bathing. To 
save the child from infection we should instill into those who have 
charge of it the danger that may arise from sleeping with, kissing, 
living in a small, confined room with parents or relatives already dis- 
eased, and insist upon the necessity of efficient ventilation. Infection 
by food is not so common, but it may be caused by the milk of a dis- 
eased cow ; boiling the milk removes this danger ; and tubercular 
mothers should not nurse their children. The author evidently con- 
siders tuberculosis and scrofulosis as identical, at least, so far as their 
prophylaxis is concerned. 

DR. JOHN M. KEATING, OF PHILADELPHIA. 

In the Medical and Surgical Reporter, 1882, this teacher says that 
the treatment of the scrofulous diathesis should be both prophylactic 
and curative. We should see that our little patients who present this 
diathesis have plenty of warm clothing, fresh air and sunlight, occasional 
trips to the sea-side, with salt baths, etc. We should also see that their 
diet is carefully regulated and nutritious ; an important article of the 
dietary is good, rich milk. The digestive organs should receive a large 
share of your attention. See that they are in perfect condition and 
21 



322 DISEASES OF CHILDREN. 

maintain them so, if possible. You should order a proper amount of 
physical exercise, with little mental labor. 

For the curative treatment our sheet-anchor is cod-liver oil, iron and 
iodine ; the two latter may be combined as the syrup of the iodide of 
iron, or you may use the tr. ferri chlor. An important reinforcement 
to the cod-liver oil is the lacto-phosphate of lime. Tonics should not be 
given until vou have corrected all evidences of marked intestinal 
derangement. Alcoholic stimulants must be used in moderation. He 
prefers the light wines or malt liquors to the stronger stimulants. 
Local ailments should be especially attended to. For glandular swelling 
you may use iodide of pot. 5j> ung. stramon. 5j? or the ointment of the 
red iodide of mercury. 

For the conjunctivitis he uses atropia sulph. gr.ij-5j ; when 
phlyctenule occur, you may dust with calomel. 

The various skin eruptions, bone affections, etc., attendant upon this 
diathesis, need but little modification of your general plan of treatment. 



SPASM OF THE GLOTTIS. 

DR. EDWARD HENOCH, OE BERLIN. 

The main indication in the treatment of this affection is to build up 
the system, as it usually occurs in rachitic children. When it becomes 
necessary to put a stop as rapidly as possible to the enormous frequency 
of the spasms and the consequent exhaustion of the child, he employs 
morphia without any hesitation. 

359. R . Morphias acetat., gr. \-\ 

Aq. destil., ^j 

Syr. alth., 3iv. M. 

S. — Teaspoonful two or three times daily. 

As soon as the patient becomes quiet and drowsy, its use should be 
discontinued to avoid toxic effects. The therapeutic consideration of the 
reflex irritants occupies the first place, if symptomatic treatment is not 
immediately necessary ; protection from cold air, treatment of any 
catarrh that may be present, purgatives in constipation, anti-dyspeptic 
remedies in dyspeptic diarrhoea. 



SPEUE — STOMATITIS. 323 

SPRUE. 



According to this author the local treatment of sprue only promises 
success in the milder cases. Mechanical rubbing is usually sufficient. 
The attendant should vigorously rub the patches off with his finger, 
which has been surrounded with fine linen and dipped in water, even if 
this gives rise to a slight hemorrhage. Whenever a new eruption be- 
comes visible, this operation is repeated. In cases of more severity 
the case is different. The fungus can be removed by the above method 
(still better if the finger is dipped in an alkaline solution, 6 parts of 
chlorate of potash, borax or benzoate of soda to 100 parts of water) ; 
but the general disease is the chief factor and relapses will therefore 
occur continually. Under these circumstances, he has with advantage, 
repeatedly brushed the entire mucous membrane of the mouth with a 
solution of nitrate of silver (1 or 2 parts to 100 of water), after the 
sprue had been rubbed of. 



STOMATITIS. 



DR. EDWARD HENOCH, OF BERLIN. 

He claims that chlorate of potash acts as a specific, and most rapidly 
in those cases associated with foetor oris and affection of the edge of 
the gums: 

360. R. Potass, clilorat., gr. xlv 

Aq. destil., £ Jiij 

Syrup, simp. f. 3 v. M. 

S. — Dessertspoonful every two hours. 

The slight pain due to the contact of the remedy with the diseased 
mucous membrane should not be taken into consideration in view of the 
surprisingly rapid disappearance of the foetor and salivation. Many 
cases recover in five or six davs ' under this treatment ; much more 
rarely we meet with obstinate cases, which resist the employment of 
chlorate of potash or even grow worse under its use. Under such 
circumstances, good results are often attained by the local application, 
two or three times daily of sulphate of zinc (1.0 to 20.0 aq. destil.), 



324 DISEASES OF CHILDREN. 

or sulphate of copper (0.5 to 20). As for noma or gangrenous ulcer- 
ation of the mouth, our author says that the treatment must be the most 
strengthening possible. In order to limit tha gangrene caustics are 
recommended, especially fuming nitric acid, liq. ferri sesquichlorati, 
concentrated carbolic acid or a thick paste formed of camphor. He has 
seen no good results from any of these agents. If the soft parts are 
already converted into a gangrenous scurf, or this has been thrown off, 
the hot iron alone can do any good, and he ad rises its use from the be- 
ginning as soon as you are sure that noma has developed in the mucous 
membrane. Pacquelin's thermo-cautery is the instrument best adapted 
to this purpose. After the gangrene has developed fully, the entire 
necrotic portion can be removed by a blade-shaped cautery -iron, and 
care must be taken to remove all the gangrenous tissue, by cutting 
within the normal tissue. But a favorable termination is not assured, 
even if the gangrene subsides after the operation, as the children may 
die from sudden collapse or from some complication, as diarrhoea or 
broncho-pneumonia. Injections with solutions of carbolic acid, salicylic 
acid, or thymol, and dressing the wound with charpie dipped in vin. 
camphorat. should not be omitted. 

THERAPEUTIQUE CONTEMPORAINE. 

This journal (1882), gives various formulae that have proved useful 
in these obstinate diseases of the mouth. The antiseptic gargle of the 
Brompton Hospital has often proved useful ; it consists of : 

361. R. Alumnus, gr. xvj 

Tinct. myrrhse, ^iss 

Aq, destil., %\s. M. 

This may be used to touch the aphthae and also as a gargle. If the 
disease proves obstinate, and no beneficial effect is obtained from the 
above mixture, Tommasi recommends the following powder : 

362. R. Calomel, ^ss 

Amyli pur., ^ss. M. 

Apply a small quantity of this over the surface of the aphthae. 
Thompson recommends in the same conditions, the following composi- 
tion : 

363. R. Tinct. opii., Tt\xlv 

Thict. catechu, 3 ijss 

Ac. sulphuric dil., rr^xlv 

Aquae rosse, ad 3 vss. M. 



SPRUE — STOMATITIS. 325 

The points affected should be touched with a camel's-hair pencil 
saturated with this mixture. 

ALFRED VOGEL, M. P. PROFESSOR IN THE UNIVERSITY OF DORPAT, 

RUSSIA. 

364. R. Sodii biboratis, 9j 

Aquae, f.gj. M. 

To be used to cleanse tbe mouth, every hour, in cases of stomatitis in 
infants. 

This feebly-alkaline solution combats the tendency of the profusely 
secreted saliva rapidly to become sour. The chest is to be protected 
against getting wet by a piece of oil-silk, which is secured under the 
jacket, and the infant is only to be allowed to drink cow's milk, with 
water. The painful ulcers may be relieved for many hours, and even 
permanently, by cauterizing them with the solid nitrate of silver. 

In idiopathic stomatitis, spontaneous recovery takes place in eight, 
or, at the longest, fourteen days. Symptomatic stomatitis in febrile 
disease does not usually call for any particular interference. 

365. R . Potassii chloratis, $ j 

Syrupi, f. g ij 

Aquse, q. s. ad f. % iv. 



The form of stomatitis known as ulcerative, presents itself as excori- 
ated patches on the surface of the gums, cheeks and tongue. There 
are usually febrile symptoms attending it, but the course of the disease 
is always with a tendency to recovery, its duration, when not checked, 
being about ten days. The local treatment required may be carried 
out with mel boracis, or chlorate of potash in solution. Internally, a 
little chlorate of potash, or other febrifuge medicine, may be adminis- 
tered. 

Gangrenous ulceration of the mouth, or noma, is mainly limited to 
children between the ages of one and five years. It may, at times, be- 
come very extensive and destroy life. In the treatment, it is, in the 
first place, of paramount importance that the patient's strength should 
be maintained by the regulated administration of food, alcohol and 
tonic medicines. Opium may be of great service. Locally, it is nec- 
essary to keep the parts cleansed; to wash them frequently with anti- 
septic fluids, and to treat the gangrenous tracts themselves freely with 



326 DISEASES OF CHILDREN. 

escharotics, of which, probably, the most valuable are pure hydro- 
chloric or nitric acid, and the actual cautery. 

NOTES ON REMEDIES. 
Alcohol, in the form of lotions of brandy and water, is recommended. 
Acidum Hydrochloricwm. This is a useful application, applied in a dilute form' 

combined with honey. It may bo used locally, and also swallowed in 

moderate doses, with benefit. Nitric acid is employed in the same 

manner and with equal advantage. 
Alumcn may be used either in solution as a wash, powdered and mixed with 

honey, or by being applied as a powder to the ulcerated spots, several 

times a day. 
Aqua Calcis. In infantile aphtha, with greenish discharges from the bowels, 

Dr. DEWEES, of Philadelphia, found great advantage from the use of 

tiiis alkali, in small quantities, with milk. 
Bismuth is recommended to be applied freely in powder. 

Gallic um Acidum, on account of its astringent qualities, is of considerable ser- 
vice in many eases. 
Mel Boi^acis is an excellent preparation, and usually readily given to infants. 
Mel Rosce has slightly stimulant and astringent qualities, and may be used in 

light cases, either alone as an addition to a mouth-wash, or undiluted, 

or combined with borax or chlorate 1 of potash. 

Potassii Chloras is probably the most, generally valuable of all applications in 

infantile stomatitis. It may boused in a, simple solid ion, powdered and 
rubbed up with honey, or in an atomized solution. Most writers speak 
of it as quite sufficient to check the disease in nearly every case. 

Sodii Boras is, next to the above, the most popular remedy for sore 1 mouth, and 
is very efficient. A favorite form is the honey of borax. The glycerole 
of borax, gj of borax to 5,j of glycerine, is a, convenient substitute. 

Sodii Chloras has been found quite as useful as the potash chlorate, and is some- 
what more soluble. 

Thymi Oleum, or Thymol, has proved advantageous in some severe cases. A 
solution of 1:3000 was used as a lotion, with which the parts were 
syringed. 



TRISMUS NEONATORUM. 

DR. EDWARD HENOCH, OF EERLIN. 

According to this author, drugs are of but little use in this disease. 
Chloral is the only remedy, under whose use (one grain hourly) he 
has seen two cases of trismus neonatorum recover. If the drug can- 



TRISMUS NEONATORUM — TUBERCULOSIS. 327 

not be swallowed, two grains should be given hourly by enema. He 
has obtained temporary relief from tincture of opium, (one drop every 
two hours,) while the narcosis lasted. On account of the extremely 
unfavorable results of all treatment in this disease, so much more im- 
portance must be attached to careful prophylaxis. Among the causes 
to be avoided, he enumerates : 

First, Injuries which affect the umbilicus. In two of his cases, the 
remains of the cord had been forcibly torn off the day after birth, and 
the wound of the umbilicus was surrounded by an inflamed zone. 

Second, The effects of thermal irritants on the skin — on the one 
hand, early exposure to cold air, (for instance, on account of baptism), 
and, on the other hand, too hot baths. This occurred in Elbing, where, 
in the practice of a busy midwife, trismus was endemic for a number 
of years, and hundreds-of children died in consequence. It was finally 
discovered that the midwife could not distinguish a temperature of 33° 
from that of 28°, and not until the thermometer was employed did the 
epidemic terminate. Attention must also be paid to the condition of 
the kidneys, since ursemic processes (resembling trismus neonatorum) 
may appear at this time of life. 

NOTES ON REMEDIES. 
Chloral has cured one case for Dr. Welch {British Medical Journal, 1881). 



TUBERQULOSIS OF THE ABDOMINAL ORGANS. 

DR. EDWARD HENOCH, OF BERLIN. 

We often have tubercles in the spleen and liver, occasionally in enor- 
mous numbers, some large, some small, so that they can hardly be 
recognized by the naked eye. The peritoneum, great omentum, the 
serous coat of the liver and spleen, the diaphragm, intestines, etc., con- 
stitute with almost equal frequency the seat of miliary tubercles, which 
are also found in the kidneys, most rarely in the internal genitalia of 
little girls. The most prominent feature is the gradual increase in the 
size of the abdomen, which is usually regarded at first as gaseous disten- 
tion, but in time arouses anxiety and causes the parents to seek medi- 
cal aid. The first glance at the abdomen will arouse the suspicions of 
an experienced physician ; after the distention of the abdomen has 



328 DISEASES OF CHILDREN. 

steadily increased for a number of months, it finally presents an ellipti- 
cal curvature ; the abdominal walls are very tense, even shining, and the 
epigastric veins are dilated into bluish cords, which show through the 
skin. The appetite suffers at the same time ; the children grow thin, 
and when the affection is fully developed, the contrast between the 
hemispherical prominent abdomen and the emaciated lower limbs is 
quite characteristic. Many children complain from the beginning of 
colic pains in the abdomen and tenderness on pressure. When the 
abdomen is very markedly distended, examination by percussion and 
palpation very often indicates the presence of an accumulation of fluid. 
In many cases these symptoms are complicated by diarrhoea, which re- 
sists all treatment or returns after short intermissions. Death occurs 
either from an accidental complication or from exhaustion. The treat- 
ment, as might be supposed, is unsatisfactory. . It must be supportive 
and hygienic, treating special symptoms as they arise. But sooner or 
later the children die from exhaustion, on account of the constant 
diarrhoea, the tuberculosis of other organs, and the hectic fever. 



TYPHOID FEVER 



DR. EDWARD HENOCH, OF BERLIN. 

This author considers that the former notion, with regard to the 
rarity of typhoid fever in children, is erroneous. He never employs 
cold baths, unless the temperature at night reaches 40° R. or more, 
and he confines himself to two baths daily, their average temperature 
being 25° R. and never below 22°. These baths act favorably in many 
children by making them feel better generally, and temporarily reliev- 
ing severe nervous symptoms that may be present. The duration of 
each bath should not exceed from five to eight minutes. Symptoms of 
collapse (tremor, coldness of the hands and feet, small pulse, pinched 
expression,) may develop after the bath and constitute a decided con- 
traindication against their continuance. In milder cases he applies an 
ice bag to the head and abdomen. When there is great restlessness he 
uses luke warm baths of 26-27° R., which not infrequently produce a 
sedative effect. In milder cases, no active antipyresis, by means of 
drugs, is requisite. A mild fluid diet (milk, broth) and four to five 



TYPHOID FEVER. 329 

spoonfuls of wine, according to age, are amply sufficient; and when a 
prescription must be given, as in private practice, we may order hydro- 
chloric acid in minute doses. In more severe cases, he replaces the 
cold bath by large doses of quinine a few hours before the nocturnal 
exacerbation, and he not infrequently employs it in combination with 
the baths. According to the antipyretic effect, the quinine is repeated 
every day or every other day. When the diarrrhoea is profuse enough 
to call for special treatment, he gives subnitrate of bismuth or tannic 
acid, with extract of nux vomica or tincture of nux vomica. Constipa- 
tion may be relieved with castor oil or an enema of water. As a rule, 
no attention need be paid to the bronchial catarrh. When it is very 
extensive or terminates in broncho-pneumonia, he orders : 

366. Be. Camphorse, gr. ss 

Acid benzoic, gr. j 

Sacch. alb., gr. v. M. 

S. — Give this powder every two hours. 

As soon as symptoms of collapse become noticeable, he gives port 
wine (a tablespoonful every two hours),, musk, camphor, or subcu- 
taneous injections of sulphuric ether. When great restlessness and in- 
somnia are present, he uses hydrate of chloral by the mouth or by the 
rectum. Above all, we must be careful to continue the fluid diet for a 
week after the cessation of the fever. 

M. JULES SIMON, OF PARIS. 

This author (Medical and Surgical Reporter, 1881,) says that the 
treatment of typhoid fever in children differs essentially from the treat- 
ment instituted for the adult. No dependence can be placed on active 
medication, or on any special remedy ; a series of indications exists, 
however, which must receive proper attention. 

These may be summed up in the phrase, " Sustain the vital forces ; 
excite or calm th,e nervous system according to the state of the patient ; 
seek to recall the cutaneous functions." During the first days the use, 
in abundance, of mild emollient drinks, is plainly indicated. 

Acidulated drinks are to be preferred, as they are refreshing and 
most agreeable to take. This will suffice at first, but after four or five 
days the administration of alcoholic preparations may be commenced. 
Alcohol acts as an excitant in certain doses, but on the other hand it is 
a well established fact that in disease accompanied by high fever it 



330 DISEASES OF CHILDREN. 

lowers the temperature and sustains the rapidly-failing vital forces. 
The form under which alcohol is administered matters little ; brandy, 
rum, or Madeira wine may be indifferently employed, proper attention 
being, of course, paid to the dose administered. 

During the first period of the malady the child is, as a rule, con- 
stipated ; but the scene soon changes, intestinal hypersecretion super- 
venes, and diarrhoea, accompanied in some cases by violent colic. In 
such cases, emollient fomentations should be applied over the abdomen, 
and enemata administered, containing two or three drops of laudanum, 
for a child from five to seven years of age. After two or three days of 
such treatment, and often sooner, the abdominal pains will become less 
intense and the meteorism less marked. 

Every three clays a small dose of some mineral purgative water may 
be given, not with the object of purging the little patient, but in order 
to clean out, as it were, the digestive tube. 

Every day enemata of water, containing, if desired, some antiseptic 
substance, may be administered. In order to excite cutaneous secre- 
tion, the whole body should be sponged with lukewarm water containing 
a little aromatic vinegar. 

Cold baths should not be employed in the treatment of infantile 
diseases ; moderately warm baths give equally good results, without 
presenting the dangers of immersion in cold water. The patient should, 
if possible, be moved from one room to another, morning and evening. 
The object of this practice is to prevent the prolonged sojourn of the 
infant in a room where the air is poisoned by the excretions and exhala- 
tions engendered during the course of the disease. The most absolute 
silence, and a darkened room, free from inopportune visitors, will prove 
of benefit. The diet should be very mild, milk and broths being the 
staple articles used for the alimentation of the patient. 

To sum up, the treatment of ordinary typhoid fever, running its 
course without notable complications, should consist in directly sustain- 
ing the forces by a milk diet, with broths and alcoholic preparations ; 
and indirectly by diminishing the intestinal secretions and combating 
the active principle of the disease by washing out the digestive tube, by 
frequent change of air, etc. 

TREATMENT OF COMPLICATIONS. 
1. Abdominal Symptoms. — When abdominal symptoms are spoken 
of, super-purgation and intense abdominal pains are generally under- 



TYPHOID FEVER. 331 

stood. The absorbents and mild astringents should be employed in such 
cases; as much as ten grams of creta preparata per diem may be 
administered in a mucilaginous julep, or four grams of subnitrate of 
bismuth in sweetened water. Enemata of starch, containing four or five 
drops of tinct. opii, may be administered ; the dose of opium being 
gradually but cautiously increased. 

In conjunction with this treatment, emollient poultices should be ap- 
plied over the abdomen, but the diarrhoea may possibly not be arrested 
for four or five days. 

2. Tlwracic Symptoms. — The most frequent are generalized bron- 
chitis and congestions of both lungs. Emetics should, in general, be 
avoided. Ipecacuanha, senega, and the preparations of antimony, should 
not be employed. All these medicaments would but depress the vital 
forces of the patient, if they did not even destroy him. 

Dry cups may be applied over the chest, morning and evening ; this 
is a simple, but powerful means of revulsion, always at the disposal of 
the physician. 

Insist on the alcoholic preparations, which you may prescribe at the 
dose of from five to seven drachms, adding, if necessary, a small quan- 
tity of extract of quinquina. 

If dyspnoea should become very urgent, a flying blister should, 
without hesitation, be applied on the chest, and should be left about 
three or four hours in situ, but never more than five or six. Thus ap- 
plied, it will suffice to produce irritation of the skin ; after its removal 
a large warm cataplasm may be applied, to aid in bringing about the 
serous effusion under the epidermis. We should not deprive ourselves 
of an agent of great power, particularly in children, in the dread of 
producing an eschar ; it is true that this accident happens more fre- 
quently in typhoid fever and in cachectic conditions of the system, but 
its occurrence may always be prevented by removing sufficiently soon 
the blistering agent. 

3. Cerebral Symptoms. — These are the symptoms against which 
therapeutic agents have least power. If the child presents symptoms 
of great cerebral excitation, chloral may be administered in the dose of 
15 or 30 grains, or an enema, containing 15 grains of chloral, 15 grains 
of camphor, and the yolk of t an egg, may be prescribed. Bromide of 
potassium should be given only as a last resource, and never for more 
than two days consecutively. 



332 DISEASES OF CHILDREN. 

4. Hemorrhage. — Intestinal hemorrhage during the course of ty- 
phoid fever is rare in children ; epistaxis is of more frequent occurrence. 
There is one simple mode of arresting hemorrhage from the nose, which 
generally proves efficacious. Agaric is cut in long strips, about half an 
inch in width ; these are introduced as deeply as possible, until the 
nostril is filled : then another is applied transversely across the external 
opening, and the whole is kept in place by a roller passed around the 
head. Sometimes it is necessary to saturate the agaric in tincture of 
ferri perchloridi. 

Plugging the posterior nares with the aid of Belloc's instrument 
should be avoided ; it is very difficult of accomplishment, on account of 
the restlessness of the child ; it induces nausea, and gives no better re- 
sults than the other method. 

When hemorrhage from the intestine occurs, administer two drops of 
tr. ferri perchlor., every half hour or every second hour. If this does 
not suffice, give cold drinks, place compresses wrung out of cold water 
on the abdomen; internally give pounded ice, which, when mixed with 
pulverized sugar, is taken without repugnance. 

5. Accidents through Compression. — Redness and eschars are in* 
duced on the parts which support the weight of the body ; they appear 
oftenest on the sacrum. An attempt should be made to prevent these 
accidents ; the pelvis of the child should be supported on an air pillow 
about two-thirds filled ; the parts should be sponged with an infusion of 
oak leaves, or with some other astringent preparation. 

In ataxo-adynamic forms, characterized by delirium with prostration, 
a blister should be immediately applied to the back of the neck ; and 
when the first has become dry, a second may be applied in the same 
place. 

Finally, in adynamic forms, in those accompanied by much prostra- 
tion, tonics and substances acting as stimulants to the nervous system 
must be insisted on. If necessary, the patient may be plunged into a 
cold bath ; a few seconds' immersion produces remarkable excitation ; 
but this is a means which should be employed only after having in vain 
tried all the others. 

DR. COLEMAN, OF VIRGINIA. 

"Masterly inactivity," according to this author (Virginia Medical 
Monthly, 1879), is the principle required in treatment. A nervine 
now and then, mild diuretics and occasional enemata. As the child 



VESICAL SPASMS. 333 

grows beyond five years of age, the disease more and more resembles 
the fever as it is found in adults ; and by the age of ten years it loses 
almost entirely its distinctive infantile form. 

He has seen the disease in children ranging from eighteen months to 
five years of age. It is marked by a daily double rise of temperature 
and corresponding remissions. Its critical days are the seventh and its 
multiple. The cutaneous abdominal eruption is much more common 
and marked than in the typhoid fever of adults. Besides, in the 
typhoid fever of children diarrhoea is absent ; and it is this absence of a 
usually prominent symptom in adults that makes the disease more or 
less obscure in children. This absence of diarrhoea in the typhoid 
fever of children is due to the fact that in them, up to five or eight 
years of age, Peyer's glands are rudimentary, and therefore do not 
suffer from the effects of the typhoid poison, as in the case of adults. 
It is a peculiar fact that the typhoid fever of old people simulalates 
very much that of children, although it is not so wanting in risk. Dr. 
Coleman regards typhoid fever as contagious, but as less so than 
scarlet fever. He believes the true cause why typhoid fever is not 
more frequent among adults is, that they had the disease in childhood. 
He has never seen a patient under ten years old die with typhoid fever, 
which favorable result, he thinks, is due to the undeveloped state of 
Peyer's glands. 



VESICAL SPASMS. 

MM. D'ESPINE AND PICOT, OF FRANCE. 

These authors consider that this form of spasm is of more frequent 
occurrence than is generally supposed, (Manuel des Maladies de 
V Enfance). It is sometimes seen in the new-born child, and is due in 
them to the accumulation in the bladder of urates of ammonia, which 
are of frequent formation in the kidney at this period of life. In very 
young children, the sudden suppression of urine, accompanied by 
agitation, should lead one to a suspicion of vesical spasm. In older 
children, frequent desire to urinate will be expressed, but such pain 
will be induced in attempting to pass water that the child will dread the 
attempt, and all trouble will cease on the spontaneous or instrumental 
evacuation of the urine. In very young children, sweet emollient 



334 DISEASES OF CHILDREN. 

drinks may be given, to aid in the elimination of the urates. For 
older children, warm cataplasms should be placed over the lower part 
of the abdomen, the child placed in a warm bath and encouraged to 
urinate therein, an ointment containing belladonna applied, and when 
the spasms recur, flannel drawers should be worn. Bokai recommends, 
also, suppositories and enemata containing small doses of opium. 



VULVITIS-APHTHOUS 



DR. PARROT, OF FRANCE. 



This author contributes to the Revue de Medecine, 1881, an exhaus- 
tive treatise on this disease, founded upon an experience of 56 cases. 
While the vulva, especially the labia majora, and less often, the labia 
minora and clitoris, are the constant seat of the disease, it may involve 
the perineum, margin of the anus, the genito-crural folds, and groins. 
At the onset, it consists of small rounded or semi-spheroidal elevations 
of the epidermis, pale or greyish white, often depressed in the centre. 
The second stage is marked by ulcers with a grey or yellowish base, 
accompanied oftentimes with severe pruritus. Under unfavorable con- 
ditions, the ulcers give place to gangrene, which may spread to an 
enormous extent. In the first stages the systemic involvement is slight, 
but when gangrene occurs severe constitutional symptoms set in, which 
may prove fatal. It is difficult to state the duration of the disease, 
but the most intractable ulcers yielded to treatment in eight days. Dr. 
Parrot does not hesitate to give a favorable prognosis in all cases. 

The treatment, whatever the stage of the disease, is to cover all the 
affected area with a uniform layer of iodoform, and over that a covering 
of lint. One application will often effect a cure, and rarely are more 
than three necessary, at intervals of twenty-four hours, preceded by 
careful washing of the parts. 



INDICES. 



I. INDEX OF DISEASES. 



Abdominal organs, tuberculosis of, 327. 

Abscess, retro-pharyngeal, 287. 

Albuminuria of scarlet fever, 298. 

Anaemia, 49. 

Ani, prolapsus, 280. 

Aphthae of the palate, 49. 

Aphthous Vulvitis, 334. 

Bronchitis acute, 50. 
Bronchitis, chronic, 58. 

Cephalhematoma, 60. 

Cholera Infantum, 60. 

Chorea, 76. 

Clinical examination of children, 18. 

Convulsions, 78. 

Coryza, 85. 

Croup, 88. 

Cyanosis febrilis perniciosa, 104. 

Dentition, 105. 

Diabetes mellitus, 109. 

Diarrhceal disorders, 110. 

Diphtheria, 144. 

Diphtheritic paralysis, 159. 

Disease, mental, in school children, 23. 

Dropsy of scarlet fever, 298. 

Eczema, 186. 

Entero-colitis, 137. 

Ephemeral fever, 192. ' 

Erysipelas neonatorum, 192. 

Erythema, 194. 

Examination, clinical, of children, 18. 

Fever, Ephemeral, 192. 
" Scarlet, 294. 
" Typhoid, 328. 

General Remarks, 17. 
Glottis, spasm of, 322. 

Haematoma of the sterno-mastoid, 195. 
Headaches, 195. 

( 



Hydrocephalus, 196. 

" spurious, 201. 

Hysteria, 203, 

Icterus neonatorum, 205. 
Incontinence of urine, 206. 
Indigestion, 207. 
Infantile paralysis, 210. 
Syphilis, 213. 
Influenza, 220. 
Intertrigo, 221. 
Intussusception, 222. 

Laryngismus Stridulus, 229. 
Laryngitis (Acute) 227. 

Malaria, 232. 

Malingering in children, 24. 

Mammary gland, enlargement of, 231. 

Measles, 289. 

Metaena neonatorum, 234. 

Meningitis (acute), 235. 

" (tubercular), 238. 

Mental disease in school children, 23. 
Mumps, 245. 

Night terrors, 246. 
Noma pudencli, 242. 

(Esophagus, foreign bodies in, 242. 
Ophthalmia neonatorum, 243. 
Organs, abdominal, tuberculosis of, 327. 

Palate, aphthae of, 49. 
Paralysis, infantile, 210. 
Parotitis, 245. 
Pavor nocturnus, 246. 
Pemphigus neonatorum, 249. 
Peritonitis, 249. 
Pertussis, 250. 
Pleuritis, 267. 
Pneumonia, 272. 

(septic), 274. 
Prolapsus Ani. 280. 
335) 



336 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



Rachitis, 282. 
Remarks, general, 17. 
Retropharyngeal abscess, 287. 
Rheumatism, 288. 
Rubeola, 289. 

Scarlet fever, 294. 

Sclerema neonatorum, 320. 

Scrofula, 320. 

Spasm of the glottis, 822. 

Spasms, vesical, 333. 

Sprue, 323. 

Sterno-mastoid, hematoma of 



195. 



Stomatitis, 323. 
Syphilis, infantile, 213. 

Trismus neonatorum, 326. 
Tuberculosis of abdominal organs, 327. 
Typhoid fever, 328. 

Urine, incontinence of, 206. 

Vesical spasms, 333. 
Vulvitis, aphthous, 334. 

Whooping cough, 250. 



II. INDEX OF REMEDIES AND REMEDIAL MEASURES. 



Acacia, in diarrhoea, 140. 
Acacia, aqua, 276. 
Acetum in croup, 102. 
Acidum aceticum, 156. 

in croup, 100. 
benzoicum, in bronchitis, 52. 
in diphtheria, 170. 
boracicum, in " , 182. 
carbolicum, in cholera infan- 
tum, 73. 

in croup, 101. 
in diarrhoea, 140. 
in diphtheria, 169, 
carbonicum, in " ,267. 

gallicum, in diarrhoea, 113. 
in stomatitis, 326. 
hydrochloricum, in cholera in- 
fantum. 61. 
in diphtheria, 161. 
in pneumonia, 273. 
hydrocyanicum, 40. 
hydrofluoricum. 182. 
lacticum, in croup, 102. 

in diphtheria, 184. 
nitricum dilutinm, 177. 
nitro-muriaticum dilutum, 164. 
nitrosum, 128. 
salicylicum, in diarrhoea, 43 

in diphtheria, 163. 
in meningitis, 236. 
in pertussis, 258. 
sulphuricum, 65. 

aromaticum, 121. 
sulphurosum, in diphtheria, 
177. 

in scarlet fever, 302. 
taimicum, 119, 



Acdium tannicum in bronchitis, 61. 
in croup, 99. 
in diarrhoea, 143. 
tartaricum, in diphtheria, 170. 
Aconitum, in croup, 96. 

in diphtheria, 172. 
Acorns, in diarrhoea, 115. 
Actual cautery, 210, 
Adipis benzoatis, 191. 
Air, fresh, in diarrhoea, 131. 

introduction of, in intussuscep- 
tion, 226. 
Air-pump for infantile paralysis, 212. 
Alcohol, in diarrhoea, 135. 
in diphtheria, 144. 
Alimentation of young children, 23. 
Alkalies in diarrhoea, 140. 

in chronic coryza, 88. 
Alteratives in diphtheria, 151. 
Alumen, in bronchitis, 53. 
in coryza, 86. 
in croup, 103. 
aceticum, 153. 
Aluminium sulphas, in croup, 97. 
Ammonium aquam, 80. 
Ammonium aromaticum, spiritus, 278. 
carbonatis, in bronchitis, 
54. 

in croup, 96. 
in diarrhoea, 140. 
in pneumonia, 274. 
chloridum, 172. 

in diphtheria, 151. 
picras, 261. 
Amyl nitrite, 261. 

in convulsions, 78. 
Amylum glyceritum, 188. 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



;37 



Anaesthetics in children, 33. 

in convulsions, 84. 
Anthelmintics, in convulsions, 78. 
Antimonial wine in bronchitis, 51. 
Antimonii et potassii tartratis in bron- 
chitis, 51. 
in croup, 95. 
Antipyrin, 34. 

Antiseptics, in diphtheria, 145. 
Antispasmodics, in chorea, 77. 

in convulsions, 82. 
Apomorphine, in croup, 103. 

in diphtheria, 178. 
in influenza, 221. 
Aquam acaciae, 276. 

bullientis, 172. 
calcis, in coryza, 85. 

in croup, 99. 
carui, 190. 
chlorinii, 178. 
Argenti iodidum, 262. 

nitras, in aphthae, 49. 

in cholera infantum, 75. 
in coryza, 86. 
in chronic coryza, 86. 
in croup, 100. 
Argenti oxiduni, 247. 
Arsenicum, in anaemia, 40. 
in chorea, 76. 
in diarrhoea, 141. 
in eczema, 187. 
Artificial feeding of infants, 37. 
Aspiration in cephalhaematoma, 60. 
Assafcetida, 247. 
Astringents, in croup, 97. 

in diarrhoea, 135. 
Atmosphere, moist, in diphtheria, 170. 
Atomization, in croup, 97. 

in diphtheria, 146. 
in laryngitis, 227. 
Atropia, in pertussis, 253. 
Axungiae, 191. 

Bael, in diarrhoea, 141. 
Balsam of Tolu, 145. 
Baptista tinctoria, 316. 
Baths of bran, 222. 

in cholera infantum, 76. 
cold, in cholera infantum, 74. 
in diarrhoea, 117. 
plunge, in chorea, 88. 
in convulsious, 85. 
of corrosive sublimate, 214. 

in pemphigus neona- 
torum, 249. 
hot, in diarrhoea, 135. 
hot mustard foot, in pneumonia, 

279. 
medicated, 44. 
salt, 44. 
22 



Baths salt, in rachitis, 283. 
steel, 44. 

tan, in diarrhoea, 126. 
tepid ammoniated, in measles, 
291. 
Belladonna, in childhood, 40. 

in cholera infantum, 75. 
in convulsions, 84. 
in croup, 98. 
in diphtheria, 172. 
in stomatitis, 106. 
Benzine, 262. 
Benzole, 266. 
Bergamot, oil of, 121. 
Bismuthi salicylas in diarrhoea, 141. 
subcarbonatis, 73. 
subnitratis in cholera infan- 
tum, 62. 
subnitratis in diarrhoea, 141. 
Black wash, 214. 
Blisters in bronchitis, 52. 

in cholera infantum, 68. 
in croup, 97. 

in diphtheritic paralysis, 177. 
in pneumonia, 273. 
Borax in croup, 91. 
Bran baths, 222. 

injections in diarrhoea, 117. 
Brandy in diarrhoea, 140. 
Bread poultices in noma pudendi, 242. 
Broininium in croup, 101. 

in diphtheria, 178. 
in pertussis, 266. 
Bryonia in pertussis, 262. 
Buchu, 107: 

Cade, oil of, in eczema, 187. 
Calcium carbolas, 266. 

lacto-phosphas, in rachitis, 287. 
phosphas, in anaemia, 48. 
salicylas, 141. 

Sulpho- carbolas in rachitis, 
287. 
Calombo, 112. 

decoction of, in diarrhoea, 
119. 
Calisaya, 247. 
Calomel in bronchitis, 50. 

in cholera infantum, 61. 
in diphtheria, 165. 
Calx, 262. 
C amphora in bronchitis, 52. 

in cholera infantum, 62. 
in coryza, 87. 
in croup, 100. 
in diarrhoea, 136. 
monobromas, 262. 
Camphorated spirit, lotion of, 193. 

vaseline, 291. 
Cantharides, 75. 



33! 



INDEX OF KEMBDIES AND REMEDIAL MEASURES, 



Capsicum, 170. 
Carbolized camphor, 173. 
Carotids, compression of, 81. 
Cascarillae, 119. 
Castanea in pertussis, 262. 
Cataplasms in vesical spasm, 334. 
Catechu in cholera infantum, 60. 

in diarrhoea, 128. 
Caiheterism of the trachea in croup, 

92. 
Cautery, actual, in infantile paralysis, 

210. 
Cauterization in diphtheria, 166. 

punctate, in prolapsus ani, 
281. 
Ceanothus Americanus in diarrhoea, 

141. 
Cerse albae in diphtheria, 145. 
Cerati simplicis, 191. 
Cerium oxalas, 75, 263. 
Chalk m diarrhoea, 141. 
Chalybeates in convulsions, 81. 
Chamois leather stockings, 211. 
Chamomile in diarrhoea, 116. 
Champagne in cholera infantum, 62. 
Chloral as an anaesthetic, 33. 
in bronchitis, 53. 
in childhood, 39. 
in convulsions, 84. 
in croup, 103. 
in diphtheria, 149. 
in night terrors, 246. 
enemas of, in diarrhoea, 117. 
Chloride of gold, 168. 
Chlorine gas, 163. 

mixture, 297. 

in diphtheria, 166. 
Chloroform in cholera infantum, 65. 
in convulsions, 78. 
in diarrhoea, 129. 
in intussusception, 224. 
inhalations of, in pertussis, 
257. 
Cicutin hydrobomate, 264. 
Cinchona for children, 25. 
bark (red), 222. 
Cinchonism in diphtheria, 150. 
Citron juice, 175. 
Clysters of opium, 114. 
Coal tar in diphtheria, 166. 
Cochineal in pertussis, 255. 
Coffee in pertussis, 256. 
Cold to the head in convulsions, 80, 82. 
in infantile diarrhoea, 115. 
pack in diphtheria, 166. 
water in incontinence, 207. 

treatment of scarlet fever, 
304. 
Collodium cantharidatum in croup, 
103. 



Colophon, 145. 

Compression of carotids, 81. 

Cooling applications in erysipelas, 193. 

treatment of measles, 292. 
Copaiba, 317. 
Cosmoline in coryza, 85. 
Cotton wadding, 275. 
Creasotum in cholera infantum, 61. 
Cresolene in pertussis, 256. 
Crotalus in scarlet fever, 301. 
Croton chloral hydrate in pertussis, 

252. 
Counter-irritation in bronchitis, 52. 

in cholera infantum, 
73. 
Cubeb pepper in diphtheria, 171. 
Cupping in bronchitis, 50. 
in pleuritis, 269. 
in pneumonia, 273. 
Cuprum sulphas in cholera infantum, 
75. 
in croup, 93. 

Decoction of poppies, 274. 
Demulcents in aphthae, 49. 
Depletion in pneumonia, 273. 
Depressants in childhood, 40. 
Diachylon ointment in eczema, 188. 
Diet in cholera infantum, 66, 72, 74. 

diarrhoea, 118, 121, 130. 

hysteria, 203. 

indigestion, 207. 

mumps, 245. 

rachitis, 282. 
Digitalis in coryza, 87. 
Disinfection in scarlet fever, 300. 
Dog's milk in rachitis, 287. 
Dorr's powder in diphtheria, 169. 
Drosera in pertussis, 255. 
Drugs, doses of, for children, 39. 

Effervescing citrate of potassium, 165. 

Elaterium, 299. 

Electricity in diphtheria, 173. 

diphtheritic paralysis, 

155, 159, 
infantile paralysis, 210. 
Elixir ferri, quiniae et strychnine in 

hydrocephalus, 200. 
Emetics in bronchitis, 51. 
childhood, 40. 
croup, 96. 
Emmollient applications, 193. 
Emplastra in cholera infantum, 76. 
Enemas in convulsions, 78, 82. 

of ice water in intussusception. 

223. 
in prolapsus ani, 281. 
Ergota, 142. 
Ergotin in prolapsus ani, 281. 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



339 



Eserine, 160. 

Ether in convulsions, 82, 267. 
Eucalyptus in diphtheria, 183. 
Excision of skin in prolapsus ani, 281. 

Farinaceous food, 122. 
Feeding, artificial, of infants, 37. 
Ferrum in diphtheria, 153. 
Ferrum ammoniatum citratis, 275. 
et ammonium citratis, 146. 

in anaemia, 
48. 
carbonas, 264. 
subcarbonas, 220. 
iodidum, 43. 

in eczema, 189. 

hydrocephalus, 198. 
syrups in coryza, 86. 
eczema, 187. 
muriaticum, in croup, 91. 
pernitratis liquoris, 278. 
phosphas, 41. 
et quiniae citratis, 137. 
sulphas in diphtheria, 183. 
sub-sulphas liquor in diph- 
theria, 184. 
chloridum, tinctura, in croup, 
91. 

diphtheria, 149. 
Fermentations in cholera infantum, 65. 
Food, farinaceous, 122. 
Fowler's solution in eczema, 187. 
Friction in infantile paralysis, 212. 

Galls, aromatic syrup of, 113. 
Galvanism in diphtheritic paralysis, 177 . 
Gargles in diphtheria, 153. 

scarlet fever, 309. 
Gentiana, 109. 

tinctura composita, 114. 
Gin in diarrhoea, 138 . 
Ginger, 177. 

Girdle, moist, in pneumonia, 280. 
Glycerine in coryza, 85. 
Glycerinae acidi carbolici, 160. 

tannici, 160. 
Glyceritum amyli, 188. 
Glyceroles, 44. 
Glycerole of starch, 194. 
Graefe's basket, 243. 
Guaiacum, 179. 
Gum water in cholera infantum, 74. 

Hsematoxylon in diarrhoea, 142. 
Hemlock in pertussis, 257. 
Hydrargyrum in infantile syphilis, 213. 
album in eczema, 187. 
chloridum corrosivum in 
coryza, 86. 
in croup, 89. 



Hydrargvrum chloridum mite in diph- 
theria/150, 153. 
Hydrargyrum cum creta, 75, 139. 

in pertussis, 251. 
cyanu return, 180. 
nitratis, in coryza, 87. 
protiodidum, 191. 
rubrum, in eczema, 187. 
sulphuretum nigrum, 

264. 
tannicum oxyclulatum, 
220. 
Hydrogen peroxide, 317. 
Hydropathy in pleuritis, 269. 
Hydrostatic pressure in intussuscep- 
tion, 225. 
Hygiene of anaemia, 47. 

chorea, 76, 77. 
schools, 26. 

tubercular meningitis, 239. 
Hypophosphites in night terrors, 247. 
Hyoscyamus in childhood, 42. 
in croup, 104. 

Ice in diphtheria, 162, 168. 

locally, in scarlet fever, 296. 
fomentations in hydrocephalus, 196. 
in prolapsus ani, 281. 
water injections in diarrhoea, 129. 
Incision in retro-pharyngeal abscess, 

287. 
Infants, new method of treating them, 

36. 
Infants, artificial feeding of, 37, 38. 
Inhalations of carbolic acid in diph- 
theria, 165. 
Inhalations of carbolic acid in per- 
tussis, 251. 
Inhalations of chloroform in pertussis, 

257. 
Inhalations of lime in croup. 91. 

oxygen in croup, 104. 
vinegar in diphtheria, 
168. 
Injections of ice water in diarrhoea, 129. 

in scarlatinal dropsy, 298. 
Intellectual hygiene, 248. 
Inunctions in diphtheria, 43. 
Iodinium in diphtheria, 184. 

tincture of, in childhood, 42. 
in diphtheria, 163. 
Iodoform in aphthae, 49. 

in diphtheria, 157. 
in hydrocephalus, 201. 
vulvitis, 334. 
Ipecacuanha in bronchitis, 50. 
Ipecacuanha in cholera infantum, 75. 
in coryza, 87. 
in diphtheria, 165. 
in hydrocephalus, 201. 



340 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



Ipecacuanha infusum radicis, 119. 
Iron in anaemia, 47. 
Irrigations of ice water in intussuscep- 
tion, 223. 

Jacket poultices, 273. 
Jersey tea in diarrhoea, 141. 
Jounod's boot in paralysis, 210. 

Kentish's ointment, 193. 
Kermes, 255. 
Kerosene in croup, 104. 

in diphtheria, 171. 
Kino in cholera infantum, 60. 

in diarrhoea, 128. 
Koumiss in diarrhoea, 126. 
Krameria, 113, 128. 

Lactopeptine in cholera infantum, 75. 
Lactucarium, 264. 
Lancing the gums, 109. 
Laparotomy in intussusception, 223. 
Laurel water, 194. 
Laxatives in intussusception, 225. 
Lead water fomentations, 194. 
Leeches in childhood, 41. 

in cholera infantum, 68. 
in convulsions, 80. 
in croup, 95. 
in hydrocephalus. 196. 
in pneumonia, 273. 
Lemon juice in croup, 91. 

in diphtheria, 170, 171. 
Lime inhalations in croup, 91. 
water in diphtheria. 161. 
Linimentum ammonise, 162. 

saponis, 275. 
Liquor picis alkalinus, 192. 
potassii, 181. 

arsenitis, 190. 
sodii chlorinate, 185. 
Lithium bromidum, 291. 
Lobelia, 264. 

Local treatment of coryza, 86. 
Lotion of camphorated spirit, 193. 
Lotions of iodine in pneumonia, 201. 
Lugol's solution of iodine, 163. 
Lycopodium, 191. 
Magnesia in convulsions. 80. 
in intertrigo, 221. 
sulphatis, 113, 137. 
Manna, 125. 
Marsh-mallow injections in diarrhoea, 

117. 
Massage in diphtheritic paralysis, 177. 

in intussusception, 223. 
Mechanical measures in rachitis, 284. 
treatment of intussuscep- 
tion, 225. 
Mel boracis, 326. 



Mel rosae, 326. 

Milk of the dog in rachitis, 287. 
diet in childhood, 32. 
hot, in diphtheria, 161. 
diet in pertussis, 257. 
pancreatized, 122. 
Mineral waters, 27. 
Mistura cretae, 110. 
Mitchell's treatment of hysteria, 203. 
Moist atmosphere in diphtheria, 170. 

girdle in pneumonia, 280. 
Monsell's solution in diphtheria, 184. 
Morphia in anaemia, 48 . 

in incontinence, 206. 
in night terrors, 246. 
in pertussis, 251. 
Moschus in convulsions, 84. 
Mustard paste, 177. 
Myrrhae, 275. 

Naphthalin, 120. 

Neurotic treatment of diarrhoea, 125. 

Nux vomica in coryza, 87. 

in paralysis, 210. 

in diphtheritic paralysis, 
176. 

(Esophageal sound in intussusception, 

227. 
Oleate of zinc, 194. 
Oleum amygdala amara, 191. 
cadini, 188. 

niorrhuae in anaemia, 48. 
in chorea, 78. 
in coryza, 86. 
in rachitis, 286. 
olivae, 106, 275. 
papaveris, inunctions of, 301. 
ricini, 110. 
succini, 275. 

terebinthinae in cholera infan- 
tum, 74. 
terebinthinae in diphtheria, 166. 
tiglii in hydrocephalus, 201. 
in pneumonia, 278. 
inunctions of, 301. 
Opiumjin childhood, 39. 

in cholera infantum, 63. 
in convulsions, 85. 
in prolapsus ani, 281. 
Opii camphoratse tinctura, 111. 

in diphtheria, 
155. 
Orris, 255. 

Oxygen, inhalations of, in croup, 104. 
Oxymellis scillae, 278. 
Ozone, how to generate, for diphtheria, 
170. 

Pancreatine, 207. 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



341 



Pancreatized milk, 122. 

Papaveris, oleum, inunctions of, 301. 

Papayotin, 181. 

Paracentesis in hydrocephalus, 196. 

thoracis, 271. 
Paregoric in croup, 97. 

in diarrhoea, 138. 
Pepsinse, 112. 

in diphtheria, 184. 
vinum, 114. 
Petroleum rectificatum in croup, 104. 
Phenic solution in croup, 91. 
Phenol sodique, 258. 
Phosphorus in ausemia, 48. 
in rachitis, 287. 
in tincture, 202. 
Picis liquidao, 192. 

aqua, 163. 
Pilocarpine, 43. 318. 
Plaster of spices, 140. 
Plumbum aceticum, 120, 156. 

iodidum unguentum, 187. 
Polygala amara in bronchitis, 52. 
Poppies, decoction of, 274. 
Pork in scarlet fever, 296. 
Potassium acetatis in coryza, 87. 
bichroinas, 181. 
bisulphites, 72. 
bromidum in cholera infan- 
tum, 68. 
bromidum in convulsions, 

85. 
bromidum in croup, 99. 
bromidum in laryngismus 

stridulus, 228. 
chloratis in coryza, 88. 
in croup, 104. 
in diphtheria, 147, 

153. 
in night terrors, 

248. 
internally, in scar- 
let fever, 303. 
in sprue, 323. 
chloridum, 155. 
iodidum in childhood, 43. 
in coryza, 86. 
in croup, 104. 
in meningitis, 235. 
nitratis in pneumonia, 273. 
permanganatis in diphthe- 
ria, 152. 
Potassse liquor, 181. 

causticas, 192. 
Poultices in bronchitis, 52. 

of bread in noma pudendi, 241. 
Ponltices in intussusception, 225. 
Poultice jackets, 273. 
Poultices of linseed meal in mumps, 245. 
of starch in eczema, 187. 



Prepuce, slitting of, for convulsions, 79. 
Pressure, hydrostatic, in intussuscep- 
tion, 225. 
Prophylactic treatment of diphtheria, 

144. 
Prophylaxis of convulsions, 83. 

of scarlet fever, 294. 
Prunus virginianus, syrupus, 276. 
Punctate cauterization, 281. 
Purgatives in hydrocephalus, 198. 

in tubercular meningitis, 
238. 

Quinia sulphatis in bronchitis, 55. 

in childhood, 42. 

in cholera infantum, 75. 

sulphatis in diphtheria, 170. 
in pneumonia, 275. 

in coryza, 85. 

tannatis, 267. 

in croup, 99. 

in pertussis, 259. 
Quinquina, 158. 

Reposition of prolapsus ani, 280. 
Resorcin in pertussis, 253. 
Rest in cholera infantum, 65. 

in horizontal position in diarrhoea, 
128. 
Revulsives in convulsions, 83. 
Rhamnus frangula, 165. 
Rheum in cholera infantum, 75. 

Salep, 160. 

Salicin in diarrhoea, 143. 
Salina3 mistura, 112. 
Salt in croup, 91. 

in diphtheria, 145. 

baths in rachitis, 283. 

pork in scarlet fever, 296. 
Sambuco water, 194. 
Sanguinaria in croup, 54. 
Sanguinaria canadensis, 155. 
Saponis tinctura camphoratae, 193. 
Sassafras in diphtheria, 185. 
Scammonium, 299. 
School hygiene, 26. 
Scilke oxymellis, 278. 

syrupus, 276. 
Scoparius, 299. 
Scutellaria, 200. 
Senega in bronchitis, 52. 

in croup, 97. 
Senna in diphtheria, 161. 
Silk stockings, 211. 
Sinapis in croup, 91. 
Slitting of prepuce for convulsions, 79. 
Sodium acetatis, 194. 

benzoatis in diarrhoea, 125. 
bisulphitis, 62. 



342 



INDEX OF REMEDIES AND REMEDIAL MEASURES. 



Sodium bisulphitis. in diphtheria, 172. 
biboratis, 91. 
bromidum, 68. 
carbolas in pertussis, 267. 
carbonates in diarrhoea, 115. 
chloridum in croup, 91. 
chlorinatum, 128. 
chlorinatae liquor, 185. 
iodidum, 214. 
nitratis, 279. 
sulphitis, 62. 
sulpho-carbolas, 295. 
Sodium sulpho-phenatis in scarlet fever, 

303. 
Spice plaster, 140. 
Spiritus aetheris nitrosi, 106. 

frumenti in diphtheria, 173. 
Sponge baths, 291. 
Sponging, tepid, in cholera infantum, 

66. 
Sponging, tepid, in diarrhoea, 129. 
Starch injections in diarrhoea, 117. 

poultice in eczema, 187. 
Stimulants in bronchitis, 57. 
in diphtheria, 157. 
in scarlet fever, 300. 
Strychnia in diphtheritic paralysis, 155, 

176. 
Succini oleum, 275. 
Sulphur in diphtheria, 173. 

in pertussis, 256. 
Suppositories of ergotin in prolapsus 

ani, 281. 
Suppositories of quinine in pneumonia, 

275. 
Surgical treatment of intussusception, 

226. 
Sweating in pertussis, 260. 
Syrupus ferri iodidi in coryza, 86. 
tolutani, 155. 

Talc powder, 221. 
Tampon in prolapsus ani, 280. 
Tan baths in diarrhoea, 126. 
Tannin in cholera infantum, 63. 

in diphtheria, 172. 
Taraxacum, 145. 

Tartarized antimony in croup, 95. 
Terebinthinae in convulsions, 81. 

in diarrhoea, 129. 

in diphtheria, 166. 
Theobroma cacao, 295. 
Thymic acid, 162. 
Thymol, 326. 

Tolutanum balsamum, 145. 
syrupus, 155. 



Tonics in chronic coryza, 88. 

in diphtheria, 157. 
Tonka bean, 266. 
Tracheotomy in croup, 89, 97. 

in diphtheria, 154, 175. 

in laryngitis, 227. 

Unguentum acidum boracicum, 188. 
aquae rosae, 191. 
hydrargyrum iodidum ru- 

brum, 322. 
hydrargyrum nitratis in 

coryza, 87. 
petrolei in eczema, 188. 
picis liquidse, 188. 
plumbum iodidum, 187. 
zinci oxidum benzoatum, 

187. 

Valeriana in croup, 104. 

in meningitis, 143. 
Van Swieten's liquor, 191. 
Varnishes in diphtheria, 162. 
Vaselini, 186. 
Venesection in convulsions, 82, 299. 

in meningitis, 236. 
Veratrum viride in bronchitis, 52. 
in croup, 97. 
in measles, 292. 
Vinegar in diphtheria, 157. 
Vinum antimonium, 292. 

in bronchitis, 51. 
ferrum amari, 190. 

Walnut leaves in eczema, 188. 
Warm baths in scarlet fever, 307. 
Water, cold, in diptheria, 157. 

in incontinence, 207. 
ice, injections of, in diarrhoea, 

129. 
warm, injections of, in intussus- 
ception, 224. 

Yeast in scarlet fever, 296. 

Zincurn oxidum in cholera infantum, 
76. 
in convulsions, 85. 
in coryza, 88. 
in diarrhoea, 117. 
benzoatum in eczema, 
187. 
sulphas in aphthae. 49. 

in bronchitis, 54. 
Zingiberis, 112. 



INDEX OF AUTHORS. 



343 



III. INDEX OF AUTHORS. 



Adams, Samuel S., 206. 
Aitkin, Dr. England, 143, 287. 
Aldridge, R., England, 317. 
Alley, Dr., Boston, 294. 
Archambault, Dr.. Paris, 158, 216, 253, 

308. 
Armstrong, J. M., Iowa, 185. 
Atkinson, W. B., Philadelphia, 63, 126, 

248, 305. 
Ayler, John W., West Virginia, 303. 

Barety, M., Nice, 265. 

Barker, Fordyce, New York, 98. 

Barling, Thomas, Michigan, 170. 

Barlow, Thomas, England, 271. 

Barthez, Dr., 294. 

Bartholow, Roberts, Philadelphia, 58, 

206, 317. 
Bartlett, F. W., Buffalo, 182. 
Bartley, E. H., ffew York, 139. 
Bates, James, Ohio, 158. 
Battams, Scott, England, 281. 
Battershall, M. H., Massachusetts, 60. 
Bayles, George, United States, 261. 
Beal, E. J., United States, 257. 
Beates, Henry, Philadelphia, 316. 
Beauchene, Dr., 255. 
Beaumetz, Professor Dujardin, Paris, 

81. 
Beigel, Herman, London, 99. 
Bell, Charles, Scotland, 79. 
Bell, Robert, Glasgow, 149. 
Benson, J. S., Canada, 178. 
Benzon, Dr., Buccari, 157. 
Bergeron, Henri, France, 182. 
Bergesio, M., Italy, 109. 
Bernard, Dr., Fiance, 287. 
Billington, Dr., 148. 
Billotti, Tomasso, Italy, 184. 
Binz, Professor C, 265. 
Bird, Golding, London, 260. 
Blache, Dr., Paris, 116. 
Black, J. R., Ohio, 163 
Blanchez, Dr., Paris, 83. 
Bleynie, M. De, France, 168. 
Bloch, Dr., France, 171. 
Bossu, Dr., Paris, 48. 
Bottare, Dr., 262. 
Bouchufc, M., France, 33. 
Brainard, Professor, 200. 
Brakenridge, Dr., Edinburgh, 143, 295, 

318. 
Bridger, Dr., 84. 
Bristowe, John Syer, England, 325. 



Brown, Bedford, Virginia, 59, 74. 
Buchanan, Professor, Glasgow, 175. 
Bull, Dr., New York, 243. 
Burchard, Dr., 266. 
Burd, Edwin, Iowa, 192. 

Caldwell, J. J., 266. 

Camden, J. S., England, 315. 

Camman, Dr., New York, 32. 

Campbell, A. W., Georgia, 126. 

Campbell, Watson, Scotland, 184. 

Carney, R., 183. 

Carpenter, W. W., United States, 148, 

197. 
Chapman, Professor E. N., Brooklyn, 

144, 198. 
Chapman, W. C, Ohio, 97. 
Charteris, Professor M., Glasgow, 291, 

299. 
Chewning, J., Illinois, 236. 
Chiricozzi, Dr., Italy, 264. 
Clark, T., England, 263. 
Clymer, Meredith, New York, 71. 
Cohen, J. Solis, Philadelphia, 228, 266. 
Coleman, Dr. Virginia, 332. 
Colsman, Dr. Barmen, 243. 
Comegys, C. G., Cincinnati, 115. 
Coons, J. N., Missouri, 155. 
Cooper, John, Philadelphia, 266. 
Coopreider, J., Indiana, 263. 
Copeman, Edward, England, 316. 
Copland, Dr., 200. 
Cormac, Sir John Rose, Paris, 176. 
Corson, Hiram, Pennsylvania, 292, 296. 
Craig, James, Jersey City, 139. 
Craigen, W. J., Maryland, 36. 
Cregny, M., France, 172. 
Curran, Robert J., New York, 164. 
Curran, Waring, 184. 
Currie, James, London, 296. 

Da Costa, J. M., Philadelphia, 54. 

Davidson, L. A., West Virginia, 143. 

Davis, N. S., Chicago, 73, 200. 

Davis, Dr., New York, 292. 

Day, Dr., Australia, 144, 317. 

Day, Dr., London, 195, 228. 

Dellenbaugh, Z. T., 261. 

Delthil, M., France, 166. 

Dem me Professor, Switzerland, 43, 318. 

De Pontives, Dr., 103. 

D'Espine, Dr., France, 333. 

Dessau, S. Henry, New York, 110, 270. 



344 



INDEX OF AUTHORS. 



Dewees, Dr., Philadelphia, 326. 

Dolan, Dr., England, 258. 

Drysdale, Thomas R., Philadelphia, 

147, 318. 
Duer, Dr., Philadelphia, 180. 
Duhring, Louis A., Philadelphia, 188. 
Dujardin-Beaumetz, Professor, Paris, 

103, 256. 
Dunbar, E. W., Zurich, 208. 
Dunn, Hugh P., England, 196. 
Dusait, M.. 287. 
Duval, E. R., Arkansas, 92. 

Eagan, J. EL, Tennessee, 256. 

Earle, Charles W., Illinois, 238, 294, 

318. 
Elliotson, Dr., 102. 
Elliott, Christopher, 141. 
Ellis, Edward, London, 41, 87, 213, 

245, 270. 
Emerson, E. W., Boston, 76. 
Erich, Dr., 169. 
Erichsen, A., 180. 
Ewald, C. A., Berlin, 129. 

Fahie, Charles J., England, 91. 

Farquhar, Dr., Ohio, 263. 

Farquharson, Robert, London, 39. 

Farrine, Dr., Tunis, 179. 

Fennel, Sidney, 317. 

Fenton, Thomas H., Philadelphia, 27. 

Fera, Dr., 184. 

Ferguson, John, Toronto, 192. 

Filataff, Dr., Russia, 220. 

Forchheimer, Professor F., Ohio, 203, 

285. 
Gorster, Dr., Germany, 321. 
Fothergill, J. Milner, London, 40, 48. 
Fowler, R., United States, 53. 

Galezowski, M., Paris, 243. 

Garretson, James E., Philadelphia, 106. 

Gasparine, Dr., Italy, 166. 

Gebhard, Lewis P., 307. 

Geiger, A., Ohio, 224. 

Gemmell, Dr., Germany, 45. 

Gerne. Paul, France, 3U3. 

Gerth, A., Switzerland, 267. 

Getz, H. L., Iowa, 161. 

Gillette, W. R., 224. 

Golis, Professor, Vienna, 198. 

Goodell, William, Philadelphia, 287. 

Gregory, C. L., Ohio, 75. 

Greenway, Henry, England, 238. 

Gross, W. M., Illinois, 75. 

Gross, Professor S. D., Philadelphia, 

197, 206. 
Guaita, Dr., Italy, 125. 
Guillon, Dr., Algiers, 103. 
Gurney, Thomas, England, 164. 



Hager, M., Germany, 145. 

Hall, Dr. M., 46. 

Hamilton, Allen McLane, New York, 

210. 
Hammond, William A., New York, 210. 
Hanks, Dr., 180. 
Harkin, Dr., Ireland, 248. 
Harman, G. H., United States, 294. 
Hartshorne, Henry, Philadelphia, 75. 
Harvey, Ellwood, Pennsylvania, 68. 
Hawley, James S., New York, 112. 
Hay, Thomas, Philadelphia, 73. 
Haywood, John W., London, 301. 
Hendy, George, Michigan, 222. 
Henoch, Edward, Berlin, 17, 47, 153, 

186, 194, 231, 256, 269, 320. 
Hepburn, W. M., Pennsylvania, 184. 
Heuser, P., Germany, 301. 
Higgins, J. J., New York, 101. 
Hill, G., England, 104. 
Hill, J. Shelton, Maryland, 265. 
Hillier, Thomas, London, 82, 112, 150, 

276. 
Holmes, T. K., Ontario, 83. 
Holt, Dr., 234. 

Hortz, F. C, New York, 183. 
Hubbard, S. P., United States, 141. 
Huebner, Dr., France, 29. 
Hutchinson, R. W., New York, 97. 

Illingworth, C. R., England, 97, 181. 
Ingalls, E. Fletcher, Chicago, 227. 

Jaccoud, Dr., Paris, 293. 
Jackson, S. K., Virginia, 62. 
Jacobi, A., New York, 94, 130. 
Jenner, Sir William, England, 283. 
Johnson, L. C, United States, 319. 
Jones, R. A., England, 207. 
Julian, J. M., United States, 54. 

Keating, John M., Philadelphia, 27, 

275, 321. 
Kennard, Dr., St. Louis, 185. 
Kennedy, Henry, Ireland, 257. 
Kennedy, Stiles, Michigan, 297. 
Kenton, J. C, Glasgow, 143. 
Kilner, Dr., England, 141. 
King, W. S., 262. 
Klamm, M., 221. 

Klebs, Professor, Germany, 144, 181. 
Klinginsmith, J. P., Pennsylvania, 90. 
Korach, S., Cologne, 157. 
Kretschmar, P. H., New York, 151. 

Landur, M., 269. 
Lannelonque, Dr., France, 242. 
Larrabee, John A., Kentucky, 162, 294. 
Lasear, M., France, 187. 
Lasinsky, Dr., 265. 



INDEX OF AUTHORS. 



345 



Laurence, H. C, England, 160. 

Ledamencla, Professor, 34. 

Leeds, Albert R., Hoboken, 38. 

Lees, Dr., England. 125. 

Leichtenstern, Dr., 305. 

Lervis, Dr., France, 304. 

Lesdorf, Dr., 102. 

Lesser, Dr., 264. 

Letzerich, Dr., 265. 

Lewis, J., New York, 87. 

Lochner,.Dr., 362. 

Lorenzo, Dr., Italy, 194. 

Lou vert, -Lamar Dr., France, 262. 

Lownds, T. M., England, 152. 

Lundy, C. J., United States, 26. 

Lush, W. V.. England, 309. 

Luton, Dr., 256. 

Lynn, George A., Pennsylvania, 167. 

Macdonald, K. N., Scotland, 302. 

MacEwen, W., Glasgow, 93. 

Macfarlane, W., Australia, 262. 

MacKeekan, Dr., Canada, 264. 

MacKenzie, M., London, 162. 

Malmgrem, Dr., 24. 

Martin, W. L., New Jersey, 91. 

Maxwell. Dr., 262. 

Maynard, Dr., 185. 

McDonald, A., Scotland, 265. 

McKee, Dr.. South Carolina, 294. 

McKenna, Dr., London, 115. 

McNider, Dr., United States, 76. 

McNutt, Dr., 262. 

Mecray, Dr., Cape May, 139. 

Meigs, Dr. Philadelpha, 37. 

Meigs, A. V., Philadelphia, 45, 189, 

228, 239. 
Melsheimer, C. T., Indiana, J182. 
Meredith, M., Iowa, 185. 
Mervel, Dr., Ohio, 273. 
Metcalfe, Professor, New York, 177. 
Mitchell, Giles, United States, 315. 
Mitchell, S. Weir, Philadelphia, 203. 
Moizard, Dr., France, 248. 
Moncorvo, Dr., Rio de Janeiro, 252. 
Montgomery, E. E., Philadelphia, 175. 
Monti, Professor, Vienna, 220. 
Moore, J. W. New York, 163. 
Moore, R. L., United States, 22, 36, 

139, 192. 
Moore, V. H., Ontario, 252. 
Morje, Dr., New York, 263. 
Morris, Dr., 170. 
Munk, Jacques, 264. 
Murdoch, S., Missouri, 146. 
Murphy, J., Illinois, 307. 
Musicautoff, Dr., Warsaw, 103. 

Niemeyer, Felix von, Tubingen, 99, 
260, 316. 



Nye, H., Pennsylvania, 169. 

Oglesby, W. W., Oregon, 178. 
Oliver, J. P., United States, 140. 

Page, J. R., Baltimore, 171. 

Parish, W. H., Philadelphia, 187. 

Parker, R. W., England, 271. 

Parker, W. Thornton, United States 
Army, 265. 

Parrot, Dr., France, 334. 

Pavesi, Carlo, Italy, 149. 

Pennell, W. W., Ohio, 138. 

Penrose, Professor R. A. F., Philadel- 
phia, 205. 

Penzoldt, Dr., Germany, 34. 

Pepper. William, Philadelphia, 45, 89, 
188, 210, 230. 

Perati, M., France, 173. 

Percivall, Dr., Maryland, 169. 

Pernot, Dr., France, 267. 

Peters, J. C, New York, 295. 

Picot, Dr., France, 333. 

Pigeon, Henry, England, 318. 

Plant, W. T., New York, 235. 

Pocock, E., London, 115. 

Polaillon, Dr., 84. 

Politzer, Dr., Vienna, 30. 

Polk, W. K., New York, 289. 

Pollak, Dr., Austria, 267. 

Pollock, C, Indiana, 79. 

Porcher, F. P., South Carolina, 151, 294. 

Porter, P. B., New York, 215, 263, 282. 

Powell, W. B., Louisiana, 168, 289. 

Prestwich, M., England, 264. 

Pritchard, Owen, England, 316. 

Purefoy, Dr., Ireland, 242. 

Ramskill, J. S., 198. 

Ravenburg, Rudolph, United States, 

142. 
Read, A. N., Ohio, 199. 
Redenbacher, Dr., 103. 
Reece, Madison, 180. 
Reid, E. M., 182. 
Reynolds, John, London, 259. 
Rhett, B., Charleston, 152. 
Rilliet, Dr., 294. 
Ringer, S., London, 48. 
Ritchie, C. C, England, 282. 
Roberts, F. E., Iowa, 178. 
Roberts, F. T., England, 298. 
Robinson, T., England, 272. 
Rokitansky, Dr., 179. 
Rooke, M., England, 229. 
Rossbach, Professor, Jena, 120. 
Rowand, A., England, 317. 

Sabbata, Dr. De, Venice, 183. 
Sankey, W. H. O., England, 264. 



84(5 



INDEX OF AUTHORS. 



Sansom, Ernest, 287, 295. 

Sartorius, Dr., Germany, 34. 

Sawarosky, Dr., 261. 

Scarff, Dr., Maryland, 96. 

Schaeffer, Dr., 181. 

Schiltz, Dr., Germany, 178. 

Schultz, O. T., 90. 

Sedgwick, C, 183. 

Semple, A., London, 18, 60, 153, 205, 

250, 273. 
Shearer, F., Scotland, 318. 
Shearer, J. Y., Pennsylvania, 304. 
Shellden, Dr., 181. 
Slmttee, H. C, Missouri, 63, 121. 
Sieffert, R., United States, 165. 
Silbermann, O., Germany, 249, 274. 
Simon, Jules, Paris, 24, 62, 276, 329. 
Smith, E., London, 277. 
Smith, G. K., New York, 173. 
Smith, J. L., New York, 52, 70, 121, 

145, 278. 
Smith, Q. C, Texas, 291. 
Smith, Q. C, California, 280. 
Snow, E. M., Rhode Island, 262. 
Spring, J. Y., Arkansas, 126. 
Squire, W., London, 179. 
Starr, L. A., Philadelphia, 207, 267. 
Stebbins, S. G., United States, 23. 
Steiner, J., Prague, 55, 84, 220, 258. 
Stewart, G. F., Tennessee, 181. 
Stewart, William, 103. 
Stierlin, Dr. Schaffhausen, 59. 
Stille, Professor A., Philadelphia, 294. 
Strahan, J., England, 201. 
Swan, C. F., Chicago, 265. 
Sweeting, Dr., 315. 
Sweringen, H. V., Indiana, 96, 150. 
Symonds, Dr., 186. 

Tanner, J. H., London, 152. 

Taube, Dr., 186. 

Taylor, Dr., Baltimore, 104. 

Taylor, R. W., New York, 214. 

Taylor, W. T., Philadelphia, 232. 

Thibon, M., Belgium, 93. 

Thomas, Dr., 218. 

Thompson, W. H., New York, 298, 316. 

Thorowgood, J. C, England, 59, 213. 

Tordens, Dr., 265. 

Treichler, Dr., 195. 



Trideau, M., 179. 

Trousseau, Professor, Paris, 296. 

Trouve. M., France, 159. 

Turk, T., 115. 

Turner, R. S., Scotland, 201. 

Tyson, James L., Philadelphia, 117, 148. 

Uhler, Dr., Baltimore, 75. 
Ullmann, E., Vienna, 143. 
Underwood, Dr., 193. 

Vidal, Professor, Paris, 175, 188. 
Vigier, P., France, 255. 
Vogel, A., Russia, 114, 325. 
Vogelsang, Dr., Switzerland, 266. 
Voje, J. H., Wisconsin, 158. 
Vovard, M., Bordeaux, 235. 

Waddell, J. A., Virginia, 165. 
Wade, De Witt C, United States, 44. 
Wagner, Dr., Fribourg, 184. 
Walker, J. B., Philadelphia., 295. 
Wallace, Professor E., Philadelphia, 

199. 
Wardell, Dr., England, 229. 
Waring, E. J., London, 41. 
Warren, J. H., Boston, 162. 
Warren, Dr., 181. 
Warring- Curran, Dr., 184. 
Webb, W. C, 253. 
Weber, L., New York, 279. 
Welch, Dr., England, 327. 
Wertheimber, Dr., Munich, 222. 
West, C, 198. 
White, W. H., 184. 
Whitehead, P.F., 180. 
Widerhofer, Professor, Austria, 228. 
Wilcox, R. W., Missouri, 188. 
Wilks, S.. England, 299. 
Wilson, E. England, 293, 316. 
Wimtreben, Dr., France, 266. 
Winkel, F., Germany, 104. 
Wood, A., Edinburgh, 294. 
Wood, R., North Carolina, 185. 
Wood, H. C, Philadelphia, 59. 
Worthington, A., Canada, 157, 304. 
Wiss, E., Prussia, 151. 

Yeats, W., 179. 



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IV. General Medicine, including the History of Medicine, State Medicine, 

Epidemiology and Animal and Vegetable Parasites. 
V. Clinical Medicine, divided into General and Local Diseases. 
VI. Obstetrics, Diseases of Women and Diseases of Children. 
VII. Surgery, including General, Military and Mechanical Surgery, Local Sur- 
gery, Diseases of the Skin and Venereal Diseases. 

Of the various Retrospects and Abstracts published in this country this is the only 
one which gives at once full and fair attention to American as well as Foreign medi- 
cal writers, and as such, and on account of its intrinsic excellence, it deserves the 
especial support of the American profession. Every number is illustrated, and is 
indexed and complete in itself 

The Compendium, while an independent publication, is arranged to be taken along 
ivith the Reporter. The same article does not appear in both journals ; the Com- 
pendium is made up with a view to include no article which has been or will be 
printed in the pages of the Reporter. Hence the two periodicals are complementary 
of each other, while still wholly independent. 

PRICES. 

The regular price for the Compendium for one year (two numbers, 300 pages 
each, bound in paper,) is $2.50. 

A discount is allowed on the Reporter and Compendium when taken togetner, 
as follows : 

The Weekly Medical and Surgical Reporter, - $5 00 

The Quarterly Compendium of Medical Science, - - 2 50 
The Reporter and Compendium, taken together, - - 6 00 
B^* Payable in advance, direct to the publisher. 

A Table of Contents of a number of the Compendium will be sent, on 
application to the publisher. 

A single copy will be sent, for examination, for One Dollar. 



THE 

"MODERN THERAPEUTICS" 

SERIES.. 

I, Modern Medical Therapeutics. 

A Compendium of Recent Formulae and Specific Therapeutical 
Directions, from the practice of eminent contemporary physicians, 
American and foreign. By George H. Napheys, a.m., m.d. Eighth 
Edition. Edited by Joseph F. Edwards, m.d., and D. G. Brinton, 
m.d. One volume, 8vo, pp. 629. Price, Cloth, $4.00; Sheep, $5.00. 

II, Modern Surgical Therapeutics, 

A Compendium of Current Formulae, Approved Dressings and 
Specific Methods for the Treatment of Surgical Diseases and 
Injuries. By George H. Napheys, a.m., m.d. Seventh Edition. One 
volume, 8vo, pp. 608. Price, Cloth, $4.00 ; Sheep, $5.00. 

Ill, Therapeutics of Gynecology and Obstetrics. 

Edited by William B. Atkinson, m.d., etc. • Second Edition. 
Greatly Enlarged. One volume, 8vo. 

Price, Cloth, $4.00; Sheep, $5.00. 



